Respiratory Flashcards
What is the treatment of stable COPD?
Initial empirical treatment, offer a short acting bronchodilator as required to relieve breathlessness and exercise Limitation
This can either be a SABA or SAMA
How would you manage acute exacerbation of COPD?
Management
The emergency management of Chronic Obstructive Pulmonary Disease centres around oxygen, bronchodilators and steroids.
Oxygen Therapy
Sit-up
24% O2 via Venturi mask: SpO2 88-92%,
Vary FiO2 and SpO2 target according to Arterial Blood Gas
Nebulised Bronchodilators (Air Driven)
Salbutamol 5mg/4h
Ipratropium 0.5mg/6h
Steroids
Hydrocortisone 200mg IV
Prednisolone 40mg PO for 7-14d
Antibiotics (if evidence of infection)
Further treatments if no response (considering pre-morbid status)
Repeat Nebulisers and consider aminophylline IV
Consider NIV (BiPAP) if pH <7.35 and/or RR >30
Consider invasive ventilation if pH<7.26
How would you manage aspiration pneumonia?
IV cephalosporin and IV metronidazole
What is the management of croup?
Can be remembered as ODA..
Oxygen (humidified)
Dexamethasone PO 0.15/kg or budenosideneb 2mg
Adrenaline nebulised 5ml (1:5000)
How do you treat lung abscess?
Conservative management:
Chest physiotherapy for postural drainage
Smoking cessation therapy if necessary
Medical management:
Supportive treatment: Oxygen; fluid Regime; analgesia
Antibiotic treatment: Intravenous therapy for 3 weeks followed by oral antibiotics for 1-2 months.
Surgical management:
CT-guided percutaneous drainage or pulmonary resection
What is the management of obstructive sleep apnoea?
Weight loss
Smoking cessation
Alcohol avoidance in the evening (sedative effect)
CPAP (Continuous positive airway pressure) maintains upper airway patency and is the gold standard
What is the management of pleural effusion?
The underlying cause should be treated and the patient should be managed in an ABCDE approach, including appropriate oxygen therapy and attempts to reduce respiratory distress medically (eg. diuretics for heart failure or antibiotics for chest infections). Ultrasound-guided pleural aspiration is indicated if this fails or the patient remains symptomatic from the pleural effusion.
Other management options to be considered include:
An intercostal drain: for large pleural effusions or empyemas (pus in the pleural space).
For recurrent or persistent pleural effusions: pleurodesis (obliteration of the pleural space) may be considered. Pleurodesis can be chemical (with use of a sclerosing agent e.g. tetracycline or bleomycin) or surgical (via thoracotomy or thoracoscopy).
How do you treat PCP?
Treatment is based on clinical or radiological evidence of infection or clinical indicators of general immune deficiency.
The first choice agent in the treatment of PCP, regardless of severity, is Co-trimoxazole
Alternative therapy can be used if Co-trimoxazole does not eliminate infection. This includes Clindamycin-primaquine, dapsone, IV pentamidine.
If the patient has p02 <9.3kPa and an arterial alveolar 02 gradient >4.7kPa, is it important to consider adjuvant corticosteroids. This has a proven reduction of mortality.
What is the treatment for community acquired pneumonia?
First choice oral abx if low severity (CUrB65 score 0 or 1)
Amoxicllin 500mg 3x a day
(Doxy/clarith/erythro- if pregnant)
First choice if moderate severity;
500mh 3x a day
W/ (if atypical pathogens suspected)
Clarithromycin- 500mg 2x for 5 days
First choice antibiotics if high severity;
Co‑amoxiclav:
500/125 mg three times a day orally or 1.2 g three times a day intravenously for 5 days
With
Clarithromycin:
500 mg twice a day orally or intravenously for 5 days
Or
Erythromycin (in pregnancy):
500 mg four times a day orally for 5 days
(Levofloxacin if pen allergic)
What is the abx for HAP
First choice oral antibiotics if non severe symptoms or signs and not at higher risk of resistance- co amoxiclav
Penicillin allergy- doxycycline
Severe sx/ signs
Piperacillin with tazobactam (4.5g 3x a day)
Or Ceftriaxone
What is the management of primary pneumothorax?
Primary pneumothorax is a type of spontaneous pneumothorax with no underlying lung pathology (secondary have underlying lung pathology)
It depends on the size and the symptoms
If the primary pneumothorax is <2cm and NOT SHORT OF BREATH then conservative management os sufficient, the pt can be discharged and reviewed in the OP department in 2-4 weeks
If the pt IS short of breath or pneumothorax is >2cm the pneumothorax should be aspirated with a 16-18G cannula under local anaesthetic. If this is successful the pt can be discharged, if this fails then an intercostal drain is necessary and pt must be admitted.
What is the management of secondary pneumothorax?
Secondary pneumothorax have underlying lung pathology- COPD, asthma TB, Pneumonia, CG, idiopathic pulmonary fibrosis and neoplastic disease, can also be caused by connective tissue disorders
If the pt is NOT short of breath and the pneumothorax is <1cm then they do not require further invasive intervention but should be admitted for observation for 24 hours and administered O2 as required
If the pt is NOT short of breath and pneumothorax is 1-2cm on the CXR, if this is successful the pt can be admitted for 24 hours of observation, if this is unsuccessful and intercostal drain is necessary
If the pt is Short of breath OR the pneumothorax is >2cm on the CXR then an intercostal drain is necessary and the pt should be admitted.
What is the treatment of PE?
The duration of anticoagulation treatment depends on the aetiology of the PE. A provoked PE (identifiable risk factors e.g. surgery, peri-partum) should be treated for 3 months. An unprovoked PE should be treated for 6 months. If there is an ongoing cause (e.g. a thrombophilia) the patient should be treated for life.
What are the causes of respiratory alkalosis?
↑pH
↓pCO2
↓HCO3- (if partially compensated or chronic)
Causes; CNS infection Subarachnoid haemorrhage Panick attack PE Aspirin overdose Anaemia Hypoxia
What are the causes of type 1 respiratory failure?
Asthma
Congestive Cardiac Failure
Pulmonary embolism
Pneumonia
Pneumothorax
Low V/Q: areas that have poor ventilation with oxygen but are well perfused by blood. E.g. bronchoconstriction (Asthma), airway collapse in emphysema, mucus plug, congestive cardiac failure
High V/Q: areas of the lung with adequate ventilation but are lacking blood perfusion Eg/ Pulmonary embolism.
What would the causes of type 2 respiratory failure be?
Obstructive lung diseases – Chronic obstructive pulmonary disease
Restrictive lung diseases - idiopathic pulmonary fibrosis
Depression of the respiratory center – opiates
Neuromuscular disease – Guillan-Barre syndrome, motor neuron disease
Thoracic wall disease – rib fracture
What is the management of TB?
Isoniazid, rifampicin, ethambutol, and pyrazinamide for 2 months, then Isoniazid and rifampicin for a further 6 months.
Extended duration in TB meningitis, pericarditis, and spinal TB.
What are the side effects of Isoniazid?
Peripheral neuropathy (pyridoxine is given to prevent this) Liver toxicity
