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VIVAs > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What are some clinical features on exam for COPD?

A
  • Hyperinflated chest, reduced chest expansion
  • Increased resonance on percussion
  • Decreased breath sounds with end exp wheeze
  • Signs of RV failure in end stage
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2
Q

What Ix do you see in COPD?

A

FBE - Polycythaemia
ABG - hypoxaemia, hypercapnia
CXR - hyper expanded lungs, bullae
RFTs- Decreased FEV1/FVC ratio, normal/increased TLC, Decreased DLCO
ECG - Right heart strain, RVH, P pulmonale (large P wave in V1)

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3
Q

What criteria is used to assess severity of COPD?

A

GOLD
A, B E = Symptoms (CAT or mMRC) + Exacerbation history (>2 moderate or 1 hospital admission = E)

Stages (all have FEV1/FVC <0.7)
1 = mild, FEV1 >80%
2 = moderate, FEV1 = 50-80%
3 = Severe, FEV1 = 30 - 50%
4 = very severe, FEV1 <30%

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4
Q

What is the medical mx of COPD?

A
  • Smoking cessation
  • Bronchodilators (b2, anticholinergics)
  • Inhaled + systemic corticosteroids
  • Vaccinations
  • Oxygen therapy (aiming PaO2 60-80mmHg)
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5
Q

What is the surgical options for Mx of COPD?

A
  • Bullectomy
  • Lung volume reduction surgery (no survival benefit)
  • Lung Tx
  • Endobronchial valves
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6
Q

What are the anaesthetic goals in COPD?

A

-Optomise resp function preop
- Pro-expiratory ventilation and monitoring for gas trapping
- Optomisition for extubation

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7
Q

What are the diagnostic criteria for RVH on ECG?

A
  • RAD
  • QRS <0.12secs
  • Dominant R wave in V1 >7mm
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8
Q

What is bronchiectasis?

A

Chronic suppurative disease of the airways that can cause expiratory airflow obstruction

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9
Q

What are the causes of bronchiectasis?

A

o Congenital – cystic fibrosis
o Acquired – lung infections, localised airway obstruction, inflammation

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10
Q

What are clinical features on history of bronchiectasis?

A
  • Fever
  • Cachexia
  • Clubbing
  • Sputum
  • Pan inspiratory crackles over affected lobe
  • Signs of right heart failure
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11
Q

What is kartagener syndrome?

A

inherited ciliary dyskinesia = triad of bronchiectasis, sinusitis + situs inversus

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12
Q

What are the Ix findings in bronchiectasis?

A

FBC - anaemia of chronic disease, leukocytosis
CXR - hyperinflation, collapse in segments
PFTs - obstructive pattern followed by mixed pattern as disease progresses

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13
Q

What is the medical mx of bronchiectasis?

A
  • Smoking cessation
  • Antibiotics to prevent and treat infections
  • Mucolytic agents
  • Inhaled bronchodilators
  • Vaccinations
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14
Q

What are some anaesthetic goals in bronchiectasis?

A
  • Optomise preop - may need preop antibiotics, steroids or physio
  • Intubation required for secretion management if GA
  • Can consider DLT if unilateral bronchiectasis
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15
Q

What is asthma?

A

chronic airway inflammation, reversible expiratory airflow obstruction in response to various stimuli & bronchial hyperreactivity

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16
Q

What some exam findings in asthma?

A
  • Wheeze
  • Tachypnoea
  • Dry/productive cough
  • Prolonged forced expiratory time
  • Hyperinflated lungs
17
Q

What are some Ix findings in asthma?

A
  • ABG - either normal or if asthma attack then decreased CO2 and resp alkalosis
  • PFTs - Obstructive pattern with bronchodilator responsiveness
  • CXR - hyperinflation
  • ECG - tachycardia
18
Q

How do you classify severity of asthma?

A

Two ways:
Amount of treatment required for good control:
- Daytime symptoms <2 days/week
- Need for reliverer <2 days/week
- No Limitation of acitivity
- No Symptoms during night or waking

Good control is all of the above
Partial control is 1-2
Poor control is >2

FEV1 % predicted measurements is other way
Mild = 65-80
Moderate = 50-65
Severe = 35-50
Very severe = <35

19
Q

What are some anaesthetic goals with asthma?

A
  • Aim to suppress bronchospasm:
    Avoid histamine releasing drugs
    LMA better than ETT
    Preop ventolin
    Smooth extubation
    Use volatile
  • Pro expiratory ventilation
    Long I:E ratio
    TV 8mls/kg
    RR 6-8
    avoid PEEP
    Permissive hypercapnia
20
Q

What are the types of restrictive lung disease?

A

Acute intrinsic - pulm oedema, ARDS, aspiration
Chronic intrinsic - Sarcoidosis, pulm Fibrosis
Chronic extrinsic - deformities of skeletal system, mediastinal mass, neuromuscular disorders

21
Q

What are exam findings in restrictive lung disease?

A
  • Chest wall deformity (depending on cause)
  • Fine crackles if intersitial lung disease
  • Cor pulmonale - RV heave, Loud P2
22
Q

What are some Ix findings in restrictive lung disease?

A

FBE - polycythaemia
ABG - hypoxaemia
PFT - decrease in all lung volumes, normal FEV1/FVC
DLCO - decreased in intrinsic disease, normal in extrinsic disease

23
Q

What scoring system is used in pneumonia?

A

CURB -65

Confusion
Urea > 7
Resp rate >30
BP <90 sys

Age >65

Score >1 = inpatient treatment

24
Q

What is apnoea defined as?

A

cessation of breathing for longer than 10 seconds

25
Q

What is a hypopnoea defined as?

A

No agreed definition.
reduction in size or number of breaths compared with normal ventilation

> 30% airflow reduction with associated 4% desat is one definition

26
Q

What Ix do can you see in OSA?

A

FBE - polycythemia
ABG - hypercapnia, raised bicarb (OHS if >30)
ECG - Right heart strain, RVH, Right atrial enlargement (P wave large in V1)
Sleep study - AHI >5 = mild, >15 = moderate, >30 = severe

27
Q

What are some anaesthetic goals with OSA?

A
  • Continue CPAP throughout admission
  • Avoid sedating drugs preop
  • Avoid long acting opioids, use regional
  • Anticipate difficult BMV
  • Post op monitoring (HDU or 24hr continous pulse ox)
28
Q

What is Obestity hyperventilation syndrome?

A

nocturnal episodes of central apnoea (apnoea without respiratory efforts) reflecting progressive desensitization of the respiratory centre to nocturnal hypercarbia

29
Q

What is cystic fibrosis?

A

Autosomal recessive genetic disorder with variable expression

30
Q

What are the clinical features of cystic fibrosis?

A
  • Pulmonary obstructive disease
  • Non pulmonary disease - diabetes, pancreatic insufficency, liver disease
31
Q

What Ix do you see in cystic fibrosis?

A
  • Bloods - anaemia of chronic disease, BSL for diabetes, LFTs
  • ABG - hypoxia and hypercapnia
  • ECG - RAD, RBBB
  • TTE - evidence of cor pulmonale
  • PFTs - obstructive pattern with decrease in both FEV1 and FEV1/FVC
32
Q

What are some anaethetic goals with cystic fibrosis?

A
  • Optomise prior to surgery
  • Regional preferred to avoid airway management
  • LMA may be beneficial although cannot suction secretions
  • Avoid nasal intubations
  • Ventilate with pro-expiratory settings but also avoid high pressures
33
Q

What is pancoast syndrome?

A

neoplasm of superior lung with involvement of brachial plexus (arm/hand wasting + pain), cervical sympathetic nerves (Horner’s Syndrome), compression of blood vessels + oedema

34
Q

What is the preop assessment of lung function in lung ca?

A

3 legged stool:
1. Respiratory mechanics – PPO FEV1 >40% - minimal risk; <30% high mortality risk
2. Cardiopulmonary testing – VO2 max >15mls/kg/min acceptable = 600m on 6MWT = ~4METS. VO2max <10mls/kg/min absolute contraindication
3. Lung parenchymal function – PPO DLCO >40% good outcome; <30% non-survival

BTS guidelines - if both ppofev1 and dlco <40 % = high risk. Both >40% then average risk. In between then needs exercise testing

35
Q

How do you decide on post thoracotomy anaesthetic extubation?

A

ppoFEV1%
>40% = extubate
30-40% = depends on exercise tolerance, DLCO, comorbidities
<30% = staged weaning in ICU

VIVAs (7 decks)

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