Respiratory Flashcards
DDx Wheeze ?
BE COME CAPP
Bronchitis
Exposure to gas
Congestive heart failure
Obstruction/ FB
Mitral stenosis
Embolism
COPD
Allergic reaction
Pneumonia
Pneumonitis
Risk factors for death from asthma ?
Hx of sudden severe exacerbations
Prior intubation
Prior ICU
2 or more hospitalization
3 or more EC visits
One hospitalization or EC in last month
> 2 canisters per month
Recent corticosteroids
Difficulty perceiving severity
Comorbidities - cardio/COPD
Psych or social issues
Socioeconomic/ urban
Drug use
Pulsus Paradoxus ?
Decrease of SBP on inhalation
>10mmHg
PEFR Colours / %
Patient >5yrs old
Green 80-100%
Yellow 50-79%
Red <50% = severe
Classification of Asthma Exacerbations
Mild or moderate:
- talks in phrases, prefers sitting, not agitated, no accessory muscle use
- RR increased, HR 100-120, sats 90-95%, PEFR >50% predicted or best
Severe:
- staccato speech, sits hunched forwards/unable to lie down, agitation/somnolence
- accessory muscle use, wheezes -> silent chest, cyanosis
- RR >30 (bradypnoea late), HR >120, sats <90%, PEFR <50%, pulsus paradoxus >15mmHg (unreliable sign, might improve as resp effort diminishes)
Life-threatening:
- drowsy, confused
- silent chest
Who needs admission ?
2-3 hrs of treatment & still symptomatic
PEFR pretreatment <25%
PEFR post treatment <40%
Sats <92% off O2
Hx of poor compliance/ multiple relapses
High risk features
COPD classification at diagnosis (FEV1 % of predicted)
GOLD Classification
1. >80: mild
2. 50-79: moderate
3. 30-49: severe
4. <30: very severe
GOLD criteria of severity looks at mMRC status with CAT of > or <10, and exacerbation history
Precipitants of COPD 7x PRICKS
Pneumonia
Pneumothorax
Pulmonary oedema
Pills
Poor compliance
Plugs (mucus)
PE
Atypical pneumonia organisms?
Mycoplasma
Chlamydia
Legionella
Coxiella
Severity/risk stratifying pneumonia
- CURB-65
- PSI/PORT
C - confusion
U - Urea >7mmol/L
R - >30
B - SBP <90 / DBP <60
>65 age
Massive haemoptysis causes
INVADE
Infections
Neoplastic
Vascular
Autoimmune
Drug-related
External impact
PCP key features ?
Hypoxic
LDH >500
CXR: ground glass infiltrates
Mx: Bactrim 21 days and prednisone
Pericardial effusion features ?
Becks triad ?
1. distended neck veins
2. Muffled heart sounds
3. Low BP (obstructive shock)
ECG: electrical alternans
CXR: globular heart
POCUS: trampoline sign
Spontaneous pneumo US features
B-mode: no pleural sliding (marching ants sign)
Lung point sign (identifies where healthy lung ends and pneumo begins)
M-mode: barcode/stratosphere sign
Loss of comet tails and B-lines
Emergency conditions associated with development of ARDS
MISS PASSOPP
M - Multille blood transfusions
I - Inhalation of smoke
S - Shock
S - Severe trauma
P - Paraquat ingestion
A - Aspiration of gastric content of hydrocarbons (eg paraffin)
S - Severe bacterial pneumonia
S - Severe malaria
O - Overdose (heroin, salicylates, TCAs)
P - Pancreatitis
P - Patients submerged in salt or fresh water
Diagnosis of ARDS? Berlin Criteria
- Acute onset (<1wk)
- Predisposing condition
- Bilateral infiltrates on imaging
- PaO2/FiO2 <300mmHg with minimum PEEP 5
- No evidence of left atrial hypertension/ left heart failure/ fluid overload
Severity ?
Mild= PF 200-300
Mod= PF 100-200
Severe= PF <100
Investigations of PE
CXR:
- go look at picture!
- elevated diaphragm
- vascular diversion to upper lobes
ECG:
- sinus tachycardia, RBBB, right axis, right ventricular strain, p-pulmonale, tall R-wave in V1-V2, S1Q3T3
POCUS:
- RA and RV enlargement with poor variability of IVC
- in PSSA view: D-shaped ventricle (increased pressures from right side causing straightening of septum)
- thrombus in transit
- large pulm. artery
- tricuspid regurg
- McConnel sign (hyperdynamic apex with hypokinetic free RV wall)
- paradoxical systolic interventricular septal motion
PE - PERC criteria ?
HAD CLOTS
Hormones
Age >50yrs
DVT/PE
Coughing blood
Leg swelling
O2<95%
Tachycardia
Surgery or trauma
Classification of PE
Massive - haemodynamically unstable with signs of shock
Submassive - haemodynamically stable with right heart strain +- trop leak
Minor - haemodynamically stable without right heart strain
Well score for PE ?
EAT CHIPS
3E- Edema of leg (DVT)
3A- Alternative diagnosis not likely
1.5T- Tachycardia >100
1C - cancer
1H - haemoptysis
1.5 I - immobilization (3 days)/surgery (4wks)
1.5 P - previous DVT/PE
1 = low risk
2-6 = moderate risk
>7 = high risk
