Respiratory Flashcards
What is pneumonia?
Name pneumonia treatments.
LRTI, bacterial, inflammation with consolidation leading to infection of bronchi
Abx- oral/IV amox
Painkiller- NSAIDS
Vaccines- early pneumococcal
O2 therapy
Cough assistance
Ventilation support
Name pneumonia investigation?
Acute- ABCDE
Bloods- FBC, U&E, CRP, LFT, lactate
Obs
ECG
CXR
Sputum/ blood cultures
CURB-65
What is bronchiectasis?
Name bronchiectasis investigations?
Permanent dilation of airways leading to sputum accumulation -> inflammation -> infections
Caused by other diseases- CF, obstruction, immune, A-1AT def
Bloods- FBC, U&E, CRP, LFT,
Obs
CXR
HRCT
Spirometry
Cystic fibrosis test
Aspergillus antigen test
Sputum/ blood cultures
Name bronchiectasis management?
Antibiotics
Mucolytics
Inhaled corticosteroids
Bronchodilators
Chest physio/ airway clearance
O2 therapy
Lung transplant
Name respiratory failure investigations?
Acute= ABCDE
Bloods- FBC, U&E, CRP, LFT, TFT, CK
Obs
ABGs
Sputum cultures
ECG
Lung function- spirometry
CXR
HRCT
Name respiratory failure management?
Main goal to support oxygenation
Acute= ITU -> ABCDE
Assisted ventilation- intubation and mechanical ventilation-> invasive
Non-invasive ventilation- venturi/ non-rebreather
What is respiratory failure?
Name the causes of respiratory failure?
Failure of gas exchange/ ventilation leading to inability to maintain inadequate levels of O2= abnormal PaO2 + PaCO2
- V/Q mismatch-
shunt- good perfusion but poor ventilation= blood not undergoing gas exchange= obstruction
Physiologic dead space- good ventilation but poor perfusion (shock, PE, COPD, asthma)
- Airway obstruction
Fibrosis
Oedema
Foreign bodies
Asthma/ COPD
Compression- tumour/ lymph - Impaired ventilation (hypoventilation)
Neurological depression- drugs/ anaesthesia
Nerve impairment- injury/ inflammation
Chest wall injury
Fatigue of respiratory muscle - Impaired gas exchange
O2/CO2 unable to cross alveoli/capillary membrane
Toxic gas inhalation
Pneumonia
Sepsis
ARDS
Pneumothorax/ effusion/ oedema
What is cystic fibrosis?
Name cystic fibrosis management?
Genetic (autosomal recessive C7) delta-F508 mutation of the CFTR gene which controls Cl- and Na+ movement
Mutation= Cl- unable to pump out of epithelium -> water unable to move in -> thick mucus that clogs airways
Antibiotics
Chest physio/ clearance
Muclytics
Mental health support
Diabetes control
High calorie diet
Lung transplant
Cortiocosteroids
Lumacaftor/ Ivacaftor
Name cystic fibrosis investigation?
Sweat test- babies
Genetic testing
CXR
HRCT
Sputum cultures
Bloods
Name pulmonary embolism investigation?
What is a PE?
Bloods- D-dimer, FBC, U&E, CRP, LFT
CXR
HRCT
ABG
Thrombus formed in deep veins in lower limbs that has travelled to lungs and blocked artery
Name pulmonary embolism management?
Blood thinners- heparin/ warfarin
Name pulmonary hypertension investigations?
What is PH?
Bloods- D-dimer, FBC, U&E, CRP, LFT
CXR
ABG
ECG
ECHO
Spirometry
V/Q scan
Increased arterial pressure in lung vessels
Name pulmonary hypertension management?
Anticoagulant- warfarin
Diuretics
Digoxin
O2 therapy
Lung/ heart transplant
Balloon therapy angioplasty
Name lung cancer investigations?
2WW referral
Emergency admission
X-ray/ CT
Biopsy of lung
Lung function test
Determine pre-existing co-morbidities
MDT- patient reviewed by an MDT to ensure best outcome and correct diagnosis
Name lung cancer management?
Lobectomy- entire lung lobe removed
Wedge recession- tumour removal and a wedge of lung to ensure all cancer cells have been removed
Bi-lobectomy- 2 lobes of the right lung removed (Upper + Lower) or (Midder + Lower)
Pneumectomy- whole lung is removed (R or L)
Radiotherapy- stereotactic radiotherapy or stereotactic radiosurgery- high does to a specific region with minimal damage to surrounding tissue
Chemotherapy- cytotoxic drugs- severe side effects due to killing healthy cells
Tyrosine kinase inhibitors TKI’s- prevent cancer growth by blocking TK growth signals, only work on patients with certain genetic mutations and non-smokers
Immunotherapies- boost immune system, PDL-1 receptor blockers prevent cancers ability to hide from immune system
Pain medications
Holistic- yoga
Name asthma investigation?
What is asthma?
Bloods- FBC, U&E, LTF, CRP
Chest x-ray
ABGs- high O2 due to high RR and low CO2
Spirometry- FEV1:FVC <0.7
Challenge testing- administering histamine to induce symptoms and conform diagnosis
Skin-prick/ serum IgE
Obstructive lung condition
Chronic inflammation, swelling and constriction of bronchioles -> reversible with corticosteroids
* Excessive mucus production
* Airway obstruction
* Bronchoconstriction
Smooth muscles tighten -> airways swell -> mucus clogging airways -> difficulty moving air in/ out.
Name asthma management?
1st-line: SAB2A- salbutamol (rapid action, airway dilation)
2nd-line: Inhaled Corticosteroids (ICS)- hydrocortisone, beclometasone (reduce inflammation)
3rd-line: LABA + ICS- Symbicort, formoterol
4th-line- Leukotriene receptor antagonists (LTRAs)- alternative to LABA + ICS
Poorly controlled- biologic therapy (mabs)
Other:
Periodic assessment- step-up or step-down
Asthma education for patient
Smoking cessation/ healthy diet
Good inhaler technique
Avoiding triggers
Acute a
sthma attack= ABCDE -> IV access for drugs -> ABG ->SaO2 >94% -> SABA neb -> LABA neb -> steroids
Follow-up following attack- GP -> specialist review -> customised asthma management plan
Name COPD management?
First-line: mild= SABA and/or SAMA
Second-line if fails to improve= SAMA + LABA + ICS
Third-line: If LABA fails to improve then add LAMA -> (SABA + LABA +LAMA)
If patients don’t respond to this regime, a trial period of a SABA + LABA + LAMA + ICS can be offered for 3 months.
1st: SABA + SAMA
2nd: SABA + LABA + ICS
3rd: SABA +LABA + LAMA
4th: SABA +LABA + LAMA +ICS
MRC dyspnoea scale
Smoking cessation!!!
Pulmonary rehab- exercise/ breathing techniques
Personalised management plan
Weight management
Vaccinations
Rescue pack- antibiotics and steroids
Final step- lung transplant or bullectomy
Name COPD investigation?
Bloods- FBC, CRP, U&E, LFT, lactate
Chest x-ray- hyperinflation, bullae, flat diaphragm,
ECG- tachycardia
PFT- obstructive pattern
ABGs- reduced PaO2 and hypercapnia- unable to breath out CO2
Spirometry- grade severity from stage 1-4
Genetic testing- A1AT deficiency
Grade SOB on MRC dyspnoea scale
Name pleural effusion investigation?
Name types of effusion.
Inspection
Palpation
Percussion
Auscultation
Chest X-ray/ CT
Ultrasound
Pleural effusion- fluid in pleural space
Pneumothorax- air in pleural space
Mesothelioma- pleural malignancy
Haemothorax- blood in pleural space (trauma, cancer, embolism)
Chylothorax- lymphatic fluid in pleural space
Empyema- pus in pleural space (secondary infection)
Name pleural effusion management?
Thoracentesis- fluid/ air removal from thoracic cavity.
Needle through 7-8th intercostal space below rib to avoid nerves.
Diagnostic/therapeutic- biopsy or fluid sample
Pleural fluid protein content analysis-
Transudate- low protein content = increased capillary hydrostatic P + decreased osmotic P = fluid leakage (heart failure, cirrhosis)
Exudate- high protein content = increased capillary permeability due to inflammation (pneumonia, TB, malignancy)
CT/ X-RAY- not pneumothorax
Treatment of Underlying Cause:
• Infection: Antibiotics are prescribed for bacterial infections.
• Heart Failure: Diuretics and medications to manage heart failure may be recommended.
• Malignancies: Treatment options may include surgery, chemotherapy, or radiation therapy.
Name pneumothorax investigation?
Clinical examination
Inspection
Palpation
Percussion
Auscultation
Never CXR if tension
Name pneumothorax management?
What is pneumothorax?
Tension pneumothorax- medical emergency and refer straight to intensive care and perform thoracostomy needle decompression to relieve air (2nd IC mid-clavicular) and not delay by X-ray/CT
Other pneumothorax
History
Examination
Chest X-ray
Distinguish between PSP or SSP
Abnormal amount of air in pleural space
Open- air enters the pleural cavity but some is able to escape, intrapleural pressure does not increase dramatically
Tension- life threatening condition caused by the continuous entrance and entrapment of air into the pleural space that is not able to escape = compressing of the lungs, heart, blood vessels- underlaying conditions or trauma (open chest wound, rib fracture)- results in cardiac arrest
Likely causes bilateral hilar adenopathy?
Sarcoidosis
Infections- TB, fungal
Malignancy
A multisystem disorder characterised by the formation of non-caseating granulomas and typically presents with adenopathy in the hilar region of the lungs, hence it is usually an incidental finding on chest x-ray.
Causes- hypercalcemia, infection, immune response -> inflammation -> granuloma formation, genetic predisposition, dust/chemicals,
