Respiratory Flashcards
Describe the clinical features of pulmonary hypertension
Exertional dyspnoea
Lethargy
Fatigue
RVF – peripheral oedema & abdominal pain from hepatic congestion
Describe the management of pulmonary hypertension
Oxygen
Anticoagulation
Diuretics for oedema
Oral CCBs
Describe the management of type 1 respiratory failure
Treat underlying cause
Give oxygen
Assisted ventilation
Describe the management of type 2 respiratory failure
Treat underlying cause
Controlled oxygen therapy – should be given with care
Recheck ABG after 20 minutes, if PaCO2 steady or lower, increase O2 concentration to 28%
If this fails – consider intubation and ventilation if appropriate
Describe the different severities of asthma
Mild: no features of severe asthma, PEFR > 75%
Moderate: no feature of severe asthma, PEFR 50-75%
Severe (if any one of the following): PEFR 33-50% of best or predicted, cannot complete sentences in one breath, respiratory rate > 25, heart rate > 110/min
Life-threatening (if any one of the following): PEFR < 33% of best or predicted, sats < 92%/ABG pO2 < 8kPa, cyanosis, poor respiratory effort, near/fully silent chest, exhaustion, confusion, hypotension/arrhythmias, normal pCO2
Near fatal: raised pCO2
Describe acute asthma management
Acute asthma management: ABCDE, aim for spO2 94-98% with oxygen, ABG if sats <92%
5mg nebulised salbutamol
40mg oral prednisolone STAT
Severe: nebulised ipratropium bromide 500 micrograms, consider back to back salbutamol
Life threatening or near fatal: urgent ITU/anaesthetist assessment, urgent portable CXR, IV aminophylline & consider IV salbutamol if nebulised route ineffective
Describe differentials in eosinophilia
Asthma – some patients have eosinophilic inflammation which typically responds to steroids
Differentials: hayfever/allergies, lymphoma, SLE, eosinophilic pneumonia
Describe outpatient COPD management
COPD care bundle
Smoking cessation
Pulmonary rehabilitation
Bronchodilators
Antimuscarinics
Steroids
Mucolytics
Diet
Describe long term oxygen therapy in COPD
Extended periods of hypoxia cause renal & cardiac damage – can be prevented by LTOT (to be used at least 16 hours/day)
Offered if pO2 consistently below 7.3kPa or below 8kPa with cor pulmonale
Must be non-smokers and not retain high levels of CO2
Describe pulmonary rehabilitation in COPD
Many COPD patients with COPD avoid exercise & physical activity because breathlessness
-may lead to a vicious cycle of increasing social isolation and inactivity leading to worsening of symptoms
Pulmonary rehab – aims to break this cycle -> an MDT 6-12 week programme of supervised exercise, unsupervised home exercise, nutritional advice & disease education
Describe COPD exacerbation management
ABCDE
Oxygen – target SaO2 94-98% but if any evidence of acute/previous type 2 respiratory failure, then target SaO2 88-92%
Salbutamol and ipratropium
Steroids – prednisolone 30mg STAT and OD for 7 days
Abx if raised CRP/WCC or purulent sputum
CXR
Consider IV aminophylline
Consider NIV if type 2 resp failure & pH 7.25-7.35, pH < 7.25 consider ITU referral
Describe pneumonia management (emergency)
ABCDE
If any features of sepsis – immediately treat using sepsis pathway (NO DELAY in initiating IV abx and fluids)
If not, treat with abx as per CURB-65 score
List the CURB-65 score
C = confusion, MMT 2 or more points worse
U = urea > 7
R = > 30/min
B = < 90mmHg systolic or < 60mmHg diastolic
65 = age above 65 years
Describe the different organisms which cause pneumonia
Community acquired:
1) Common organisms – streptococcus pneumonia, haemophilus influenza, Moraxella catarrhalis
2) Atypical – legionella pneumophilia, chlamydia pneumoniae, mycoplasma pneumoniae
Hospital acquired – E.coli, MRSA, peudomonas
List the causes of a non-resolving pneumonia
CHAOS
Complication – empyema, lung abscess
Host – immunocompromised
Antibiotic – inadequate dose, poor oral absorption
Organism – resistant or unexpected organisms not covered by empirical abx
Second diagnosis – PE, cancer
Describe the hospital management of covid-19
Oxygen supplementation – CPAP or invasive ventilation
Dexamethasone (& consider tocilizumab +/- remdesivir)
Abx may be needed if suspected superadded bacterial infection
List investigations for a suspected pulmonary embolus
U&Es, FBC, baseline clotting
ECG
CXR
ABG
Serum d-dimer
CT pulmonary angiography
Describe the management of a pulmonary embolus
Acute: oxygen, morphine & anti-emetic
LMWH/fondaparinux
Long-term anticoagulation: either DOAC or warfarin
Treat underlying cause
List investigations for suspected TB
Culture
If productive cough – x3 sputum samples for acid-alcohol fast bacilli
Routine bloods (especially LFTs) & HIV test and vit D levels
Describe the management of TB
4 antibiotics for first two months – rifampicin, isoniazid, pyrazinamide, ethambutol
2 antibiotics for 4 months – rifampicin & isoniazid
Dose of anti-TB abx is weight dependent
List the major side effects of TB treatment
Rifampicin – hepatitis, rashes, orange/red secretions
Isoniazid – hepatitis, rashes, psychosis
Pyrazinamide – hepatitis, rashes, vomiting, arthralgia
Ethambutol – retrobulbar neuritis
List investigations for suspected bronchiectasis
High resolution CT
Blood tests – immunoglobulin, cystic fibrosis genotype, HIV test, RF
Sputum culture
Describe management of bronchiectasis
Treat underlying cause
Physiotherapy
10-14 abx according to sputum cultures
1) Haemophilus influenza: amoxicillin
2) Pseudomonas aeruginosa: ciprofloxacin
IV abx for severe infections
Long-term prophylactic abx for patients with recurrent infective exacerbations
List investigations for suspected cystic fibrosis
One or more of:
1) History of CF in sibling
2) Positive newborn screening result
AND:
1) Increased chloride concentration in sweat test
2) Identification of two CF mutations
3) Demonstration of abnormal nasal epithelial ion transport
