Respiratory Flashcards
different stages of acute asthma
moderate - PEFR 50-75% of predicted, RR<25, BPM <110
severe - PEFR 33-50%, cant complete sentences, RR>25, BPM >110
life-threatening - <33%, sats <92%, silent chest, cyanosis, bradycardia, dysrhythmia, hypotension, exhaustion, confusion, coma
normal PCO2 = exhaustion
management of acute asthma
admit
oxygen if hypoxaemic - 15L if acutely unwell then downtitrate to flow rate which maintains 94-98%
SABA - inhaled, nebulised
corticosteroid - 40-50mg pred PO 5 day
ipratropium bromide (SAMA)
IV magnesium sulphate
IV aminophylline
ITU/HDU - intubation and ventilation, ECMO
discharge critera for patients admitted with acute asthma
stable on discharge meds for 12-24h
inhaler technique checked and recorded
PEFR >75% best or predicted
features of acute bronchitis
clinical diagnosis
sx - cough, sore throat, rhinorrhea, wheeze, low grade fever
no other focal chest signs other than wheeze, no real systemic features (whereas pneumonia has systemic features)
overview of acute bronchitis
self limiting chest infection lasting 3w (viral) due to inflammation of trachea + major bronchi - assx with oedematous large airways and sputum production
management of acute bronchitis
CRP testing may be used to guide whether abx therapy is needed
analgesia
good fluid intake
abx if - very unwell, pre-existing co-morbidities, CRP 20-100 (delayed script), CRP >100 (immediate abx)
doxycycline
amoxicillin in children/pregnant women
infective causes of COPD exacerbations
bacteria - haemophilus influenza, streptococcus pneumoniae, moraxella catarrhalis
respiratory virus - 30% exacerbations - human rhinovirus
features of COPD exacerbations
dyspnoea, cough, wheeze
increase in sputum suggestive of an infective cause
patients may be hypoxic and in some cases have acute confusion
management of COPD exacerbations
frequent bronchodilator use + nebuliser
prednisolone 30mg 5 days
oral abx if purulent sputum or clinical signs of pneumonia (amoxicillin, clari, doxy)
admission if adverse criteria
inpatient management of COPD exacerbations
oxygen - hypercapnia risk therefore target 88-92 with 28% venturi at 4l/min, adjust to 94-98 if pCO2 normal
nebulised bronchodilator - beta-adrenergic agonist (salbutamol), muscarinic antagonists (ipatroprium)
IV hydrocortisone if needed
IV theophylline - if pt not responding to nebulised bronchodilators
NIV - if resp acidosis
overview of ARDS
due to increased permeability of alveolar capillaries causing fluid accumulation in alveoli - significant morbidity, 40% mortality
acute onset and severe
dyspnoea
elevated respiratory rate
bilateral lung crackles
low oxygen saturations
causes of ARDS
infection: sepsis, pneumonia
massive blood transfusion
trauma
smoke inhalation
acute pancreatitis
Covid-19
cardio-pulmonary bypass
criteria for ARDS
acute onset (<1w risk factor)
pulmonary edema - bilateral infiltrates on CXR
non cardiogenic
pO2 <40kPA
management of ARDS
ITU mx
oxygenation for hypoxaemia
organ support e..g, vasopressors
tx underlying cause - abs for sepsis
prone position , muscle relaxation
features of allergic bronchopulmonary aspergillosis
allergy to aspegillus spores
causes proximal bronchiectasis and bronchoconstriction (wheeze, cough, dyspnoea)
hx eosinophilia, bronchiectasis
may have previosu hs asthma
CXR features of allergic bronchopulmonary aspergillosis
eosinophilia
flitting CXR changes - ring shadow, tram track opacities shows bronchiectasis
positive radioallergosorbent (RAST) test to Aspergillus
positive IgG precipitins (not as positive as in aspergilloma)
raised IgE
management of allergic bronchopulmonary aspergillosis
oral glucocorticoids
itraconazole
overview of alpha-1 antitrypsin deficiency
AR inherited condition Chr14
lack of protease inhibitor (A1AT) which is normally produced by the liver - this protects cells from enzymes such as neutrophil elastase
causes emphysema in young, non smokers
features of alpha 1 antitrypsin deficiency
lower lobe panacinar emphysema
cirrhosis and HCC in adults, cholestasis in children
test A1AT concentration
obstructive spirometry
management of alpha 1 antitrypsin deficiency
no smoking
bronchodilators
physiotherapy
IV A1AT protein concentrates
lung volume reduction surgery, lung transplantation
risk factors for aspiration pneumonia
Poor dental hygiene
Swallowing difficulties
Prolonged hospitalization or surgical procedures
Impaired consciousness
Impaired mucociliary clearance
features of aspiration pneumonia
affects right middle and lower lobes
can be aerobic or anaerobic bacteria
main symptoms of asthma
cough - worse at night
dyspnoea
wheeze
chest tightness
expiratory wheeze
reduced PEFR
asthma management guidelines
SABA
SABA + ICS (low dose - <400mcg budesonide or eq)
SABA + ICS + LRTA
SABA + ICS + LABA (+LRTA depending on pt response)
SABA + LTRA + MART (med-dose ICS 400-800 budesonide or eq)
SABA + LTRA + high dose ICS >800mg/additional drug e.g., theophylline
drugs used in asthma management
SABA - salbutamol - relaxes smooth muscle of airways
ICS - beclomethasone
LABA - salmeterol
LRTA - montelukast
MART - ICS + LABA
investigation findings in asthma
spirometry
reduced FEV1
normal FVC
FEV1 <70%
FeNO
nitric oxide levels correlate with level of inflammation
CXR
stepping down asthma treatment
step down every 3m
reduce inhaled steroids by 25-50% at a time
features of atelectasis
postop complication
basal alveolar collapse - can lead to respiratory difficulty
dyspnoea and hypoxaemia ~72h postop
position pt upright and do chest physio
