Respiratory Flashcards
What are the symptoms of stable asthma?
Episodic symptoms with specific triggers and diurnal variation.
- Dry cough, worse at night
- Shortness of breath, chest tightness
- Wheeze
What signs would you find on examination in stable asthma?
Most likely none, unless having an attack.
May have: Audible wheeze and hyper inflated chest Tachypnoea Resonance to percussion Widespread polyphonic wheeze on auscultation
Which guidelines should you use to guide asthma management?
BTS guidelines
British Thoracic Society
What investigations should you do in suspected asthma?
Fractional exhaled nitric oxide testing Spirometry with bronchodilator reversibility testing Peak flow + PF diary Histamine challenge/allergy testing Trial with bronchodilators
What is the management algorithm for stable asthma?
- SABA- salbutamol
- ICS- beclometasone
- LABA- salmeterol
- Trial of inhaled ipratropium (SAMA) or tiotropium (LAMA)
- Trial oral montelukast (esp in children)
- Oral steroids
Lifestyle:
Annual review, smoking cessation, flu and pneumococcal vaccines.
What are the symptoms of acute asthma?
Shortness of breath, Chest tightness Audible wheeze / stridor Inability to complete full sentences Confusion / reduced GCS Use of accessory muscles to breathe Cyanosis
What are the features of a severe asthma attack?
Peak flow 33-50%
Inability to complete sentences
Resp rate >25
HR >110
What are the features of life-threatening asthma?
PEF <33% Silent chest Exhaustion and poor respiratory effort Normal PaCO2 or PaO2 <8 Reduced GCS SO2 <92%
What automatically makes an asthma attack have near-fatal classification?
Raised PaCO2
Requiring mechanical ventilation
What investigations should be done in somebody presenting with acute asthma?
A-E assessment PEF Pulse oximetry ABG CXR - if stable enough, purely for exclusion of alternative diagnoses.
How would you manage acute asthma?
High flow O2- 15L non-rebreathe Salbutamol news B2B Ipratropium nebs 4-6hrly Hydrocortisone IV or PO prednisolone if stable enough. -> Seek senior support, inform HDU/ICU -> IV magnesium sulphate -> Intubate and mechanically ventilate
? can try aminophylline infusion or IV salbutamol ? - seek advice
Post-recovery: 5 day course oral steroids
What would you expect on ABG in acute asthma?
- Respiratory alkalosis
- Hypoxia with normal CO2
- Respiratory acidosis (near fatal)
What are the symptoms of COPD?
Increasing breathlessness and reduced exercise tolerance
Chronic cough
Use of accessory muscles to aid breathing
Recurrent chest infections
What are the signs of COPD on examination?
Use of accessory muscles or pursed lip breathing Increased respiratory rate Hyper-inflated lungs Reduced chest expansion, hyper-resonance May have peripheral / central cyanosis Quiet breath sounds, bronchial breathing
What are the diagnostic criteria for COPD?
What are the different stages?
Symptom profile +
FEV1/FVC <0.7 with no bronchodilator reversibility
S1: FEV1 > 80% predicted
S2: FEV1 50-79% predicted
S3: FEV1 30-49% predicted
S4: FEV1 <30% predicted
How would you manage COPD?
Lifestyle: stop smoking = best prognostic indicator
Flu + pneumococcal vaccines
Medical:
1. SABA
2. If steroid responsible/atopic/high eosinophils: add ICS
Otherwise add LABA/LAMA / combination
3. LABA + LAMA + ICS
4. Oral steroids, home nebs, carbocysteine, LTOT, prophylactic abx
What are the indications for LTOT in COPD?
PaO2 < 7.3 despite optimal treatment
PaO2 7.3-8.0 with other complications
Contraindicated if still actively smoking due to flammability
What are the most common causative organisms in infective exacerbations of COPD?
- Haemophilus influenzae
2. Streptococcus pneumoniae
What investigations should you do in somebody presenting with infective exacerbation of COPD?
- A-E assessment
- O2 sats
- ABG- indicates severity and guides O2 therapy
- CXR
- Sputum culture
- Bloods + blood cultures
- ECG to rule out cardiac cause of presentation
How should you guide O2 therapy in COPD?
- If chronic retainers, aim sats 88-92%
- If not chronic retainers, aim sats >94%
- If acidotic on ABG -> NIV
How would you manage infective exacerbation of COPD?
- Oxygen
- At home: regular inhalers, oral antibiotics, oral steroids, regular review
- In hospital: bronchodilator nebs, IV antibiotics and steroids, chest physio
What would you expect to see on ABG in type 1 and type 2 respiratory failure?
Type 1: Low O2 and normal CO2
Type 2: Low O2 and high CO2
What are the most common causative organisms of pneumonia?
- Streptococcus Pneumoniae
2. Haemophilus influenzae
What is the most common causative organism in somebody with pneumonia who has just been treated for flu?
Staphylococcus aureus