Respiratory Flashcards
Life threatening asthma
PEFR <33% best or predicted
O2 <92%
silent chest/ cyanosis/ feeble resp effort
bradycardia/ dysrhythmia/ HoTN
exhaustion, confusion or coma
Severe asthma
Severe asthma 33-50% best or predicted
unable to complete sentences
RR >25/min
pulse > 110
Moderate asthma
PEFR 50-75% best/ predicted
speech normal
RR <25/min
HR <110
Near fatal asthma
raised pCO2 and or requiring mechanical ventilation with raised inflation pressures
Acute Asthma mx
SABA: salbutamol/ terbutaline life threatening nebulised
corticosteroid: ALL asthma 40-50mg prednisolone OD for 5 days or until pt recovers (breastfeeding 30mg OD)
ipratropium (SAMA): nebulised- severe/life threatening or NOT responding to SABA + steroid.
iv MgSO4: severe/life- threatening asthma
iv aminophylline: senior
criteria d/c asthma
stable on d/c meds 12-24hrs
check inhaler technique
PEF >75% of best or predicted value
Asthma mx- chronic
1.SABA
2. ICS + SABA
3. SABA + low dose ICS + LTRA (monteleukast)
4. SABA +ICS + LABA (continue LTRA)
5. SABA +/- LTRA switch ICS/LABA for maintenance and reliever therapy (MART incl low dose ICS)
- SABA +/- LTRA + med dose ICS MART OR consider changing back to fixed dose of mod dose ICS + separate LABA
- SABA +/- LTRA + one of
- increase ICS to high dose part of fixed dose regime not MART
- trial of addition drug eg. Long acting muscarinic R ATG or theophylline
Stages and dx of COPD
Post bronchodilation FEV/FVC is ,0.7
Stages GOLD
- FEV1 of predicted >80%
- 50-79%
- 30-49%
- <30%
Which indicates copd severity
fEV1 predicted value indicates disease severity
Ptx mx primary and secondary
Primary:
If <2cm & no sob: d/c
Otherwise attempt aspiration
If >2cm or SOB: chest drain
Secondary
If >50yrs & 2cm +/- SOB= chest drain
Attempt aspiration if 1-2cm
Typical pneumonia causes & name most common
Strep pneumonia most common
Haemophilia influenza
Morexalla catarrhalis
Staph aureus
Group A streptococcus
Aerobic gram negative: Klebisiella, e.coli
Atypical pneumonia causes & mx
Legionella
Mycoplasma
Chlamydia
Coxiella
Resp virus causes
Influenza A&B
Covid
RSV
parainfluenza
Rhinovirus
Adenovirus
Scoring system for pneumonia & mx
CURB-75
confusion
Urea>7mmol/l
Resp rate >30
BP <90/60
Age 75
Score 0-1 low risk 1st line amoxicillin nil hospital admission
2- mod risk
>3 high risk
Ddx exudative vs transudative
If protein
>30g/L exudative
If between 25-30g/L
Use light’s criteria. If one is positive then it is an exudative pleural fluid
Pleural Protein/ serum protein >0.5
Pleural LDH/ serum LDH >0.6
If pleural LDH >2/3 upper limits of normal serum LDH
Pleural effusion findings for RA and Tb
Low glucose
Pleural findings of pancreatitis and oesophageal perforation
High amylase
Mesothelioma, TB, PE leural findings
Heavy blood staining
Causes of transudative and exudative pleural findings
Transudative: increase hydrostatic and decreased oncotic pressure
CHF, cirrhosis, nephrotic syndrome, PE, hypoalbuminaemia
Exudative due to inflammation induced increased capillary permeability
Infection, cancer, tb, autoimmune, viral infection
Electrolyte findings of sarcoidosis
Hypercalcaemia as macrophages inside granuloma causes increased conversion of vid D
ACE from T-cells
Lofgrens syndrome
Acute form of disease.
Bilateral hilar lymphadenopathy, erythema nodosum, fever, polyarthalgis
Dx of sarcoidosis
Biopsy gold standard
Non-caseating granuloma with epithelium cells
What is granuloma
Walled off macrophages
Bronchitis mx
Abx only if unwell, crp>100
1st line doxycycline
Inheritance of alpha 1 anti-trypsin deificiency
AR
Chromosome 14
