Respiratory Flashcards
Asthma grades of severity
Mild-mod:
-PEFR >50% normal or predicted
-RR<25
-HR <110
Severe
-PEFR 30-50% predicted/normal
-RR >25
-HR >110
Life-threatening
-PEFR <30% normal
-silent chest
-cyanotic
-O2 sats <92
-hypotension or bradycardia
Treatment asthma mild-mod/severe/life threatening
Mild/mod
6 puffs salbutamol Q20 min +/- PO red
Home with support
Severe
6 puffs salbutamol Q20m
+ipratropium x1 dose OR use nebs
PO/IV steroids
Monitor closely
Life-threatining
Ambulance to hospital
Continuous salbutamol nebs
+1x ipratropium nebs
IV steroids
Consider intubation if required
COPD exacerbation - when to refer
Inability to perform ADLs/walk due to SOB
Unable to eat/sleep due to SOB
Significant comorbid condition
New or worsening hypoxia
Inadequate social supports
AMS
New arrythmia
Not improved post primary care
COPD exacerbation treatment
and indication for antibiotics
Two or more of: increased sputum purulence, increased sputum volume or increased SOB
Amox 500mg tds 5/7 OR
Doxy 100mg bd 5/7
Augmentin 625 tds 5/7 if treatment failure
PO pred (up to 2 weeks)
Salbutamol + ipratropium
Definition HAP
In hospital >2 days in the last 90 days
Symptoms of TB
Cough +/- sputum >3 weeks
SOB
Haemoptysis
Weight loss
Night sweats
Lymphadenopathy
Prolonged fever
Malaise/lethargy
Anorexia
Failure to thrive in children
Haemoptysis causes
Infections (#1)
-bronchiectasis (severe or recurrent pneumonia or TB)
-pneumonia
-bronchitis (only mild)
-abscess eg fungal
Neoplasm (#2)
-bronchogenic most common
-renal or colorectal most likely ca to met to bronchi
Other
-foreign body
-vasculitis/pulmonary-renal syndrome
-PE (presentin 10-20% of PE)
-pulmonary endometriosis
Management of spontaneous PTx
If <3cm from cupola to apex (or <2cm laterally at hilum) can give O2, repeat in 6 hours, if no bigger –> home
If >3cm or associated dyspnoea, hypoxia, tachycardia or hypotension will require decompression +/- chest drain
Features of asthma
Widespread wheeze
Chest tightness
Cough
SOB
Symptom pattern
-variability
-worse night and morning
-recurrent/seasonal
-began in childhood
-triggered by: cold/viruses/irritants/B-blockers/NSAIDs/allergens/exercise
Airflow obstruction on spirometry
Hx or FHx atopy
Reversible with SABA - ≥12% increase FEV1 (or 200ml) asthma more likely
Variability in PEF
Criteria for referral to hospital in asthma exacerbation
Severe or life threatening asthma
Insufficient response to SABA
Hx of brittle asthma
Hx of ICU admission for asthma
Exacerbation persisting despite steroid use pre-presentation
Living alone/socially isolated
Physical or intellectual disabilities
Night presentation
No phone/car at home
Pregnancy
Asthma good control vs partial vs poor control
Good control = all of:
Daytime sx ≤2 days per week
Need for reliever ≤2 days per week
No limitation of activities
No sx at night or on waking
Partial control = “no” to 1 or 2 of above
Poor control = “no” to 3 or 4 of above
Features of higher risk of severe asthma
Asthma features:
Poor control
Decreased lung function (FEV1 <60% pred)
High reliever use
Brittle asthma
Home nebuliser
Hx ICU admits
≥1 exacerbations req steroids/ED/hospital in past year
Raised eosinophils
Long-term steroids
Other:
Psychotropic medications
Psychosocial dysfunction or socioeconomic disadvantage
Smoking
Allergies/anaphylaxes
Alcohol/drug abuse
NSAID sensitivity
Maori/PI
Occupational asthma
Poor adherence or access to primary care
COPD definition
FEV1/FEV <0.7 post bronchodilator
(FEV1 <80% pred also a feature)
Hx of smoking or exposure to other noxious stimuli
Exertional breathlessness, cough, sputum
COPD bacteria in exacerbations
Strep pneumonia, Haemophilus influenza, Moraxella catarrhalis make up 50% of exacerbations
Minimising risk of COPD exacerbations:
Flu shot
Avoiding URTIs
Quitting smoking
Avoiding other chemical irritants
Medication use
Optimising control of co-morbidities
