Respiratory Flashcards
Well’s criteria for PE
Clinical signs of DVT (3) Pulmonary embolism most likely (3) Tachycardia (1.5) Immobilisation (1.5) Previous PE/DVT (1.5) Haemoptysis (1) Malignancy (1)
Indications for PE thrombolysis
Hypotension
Shock
Poor prognostic markers for PE
Right ventricular dysfunction Troponin elevated (negative patients will do well) ANP/BNP elevated
PFT changes in obesity
FEV1 lower FVC lower FRC lower ERC lower RV lower TLC lower tends to be a restrictive defect with low FVC with increased FEV1/FVC ration as FVC is lowered more than FEV1 is lowered
CURB65 pneumonia score
Confusion Urea > 7 RR > 30 BP < 90 or DBP < 60 65 years or older
> 2 suggests severe pneumonia at high risk of death
MDR TB
resistant to at least 2 1st line TB drugs
eg: rifampicin, isoniazid
XDR TB
resistant to rifampicin, isoniazid
AND any fluoroquinolone AND one of capreomyin, kanamycin, amikacin
a/w HIV
high mortality rate
TB Rx
RIPE 2/12
RI maintenance 4/12
longer if meningitis, disseminated, spinal, MDR, XDR
add steroids if large pleural effusion, pericardial disease, meningitis
Churg Strauss
asthma eosinophilia pulmonary infiltrates neuropathy paranasal sinus abnormality pANCA 50-60% small-medium vessel vasculitis Rx: steroids + - cyclophosphamide
Granulomatosis with polyangiitis
Wegeners granulomatosis
CXR: nodules, alveolar opacities, pleural opacities, diffuse hazy opacities
cANCA 90%
small-medium vessel vasculitis
URT, LRT, kidneys
O2 Hb dissociation curve
to the right:
shifted to the right = O2 affinity of Hb is reduced
02 unloads into tissues more readily
- exercise: (hot, acidotic, need more O2)
- acidosis (increased H+)
- increased CO2
- increased temperature
- increased 2-3 diphosphoglycerate (2,3-DPG)
small addition of CO shifts curve to the left; making it harder for O2 to get into tissues as it is more tightly bound to Hb
A-a gradient calculation
PAO2 = FiO2 (Patm - PH2O) - PaCO2/0.8
if assume at sea level on room air:
PAO2 = 150 - (5/4 PaCO2)
normal = 5-10
increases with age so: normal < age/4 + 4
increased gradient with decreased O2, CO2 or both
eg: diffusion defect, V/Q mismatch, right - left shunt
SMART COP tool for pneumonia severity
2 points for O2, pH, SBP
all else 1 point (bracket for > 50yo)
S = SBP < 90
M = multilobar on CXR
A = albumin < 35
R = RR > 25 (30 if > 50yo)
T = tachycardia > 125bpm
C = confusion
O = PaO2 < 70 (< 60)
< 93% (< 90%)
PaO2/FiO2 < 333 (< 250)
P = pH < 7.35
pleural fluid analysis
exudate?
pleural fluid : serum albumin > 0.5
pleural fluid : serum LDH > 0.6
infection, malignancy
glucose low
pH < 7.2 suggests poor prognosis / severe infx
transudate: CCF, ascites, nephrotic sx
Restrictive lung defect on RFTs with normal DLCO
normal RV - inspiratory dysfx: obesity, kyphoscoliosis, ank spond
increased RV - insp and exp dysfx: bilateral diaphragm paralysis, GBS, MG, MD
