Respiratory Flashcards
resp failure
p02 < 8kPa
type 1 CO2 normal
type 2 pCO2 > 6.0 due to hypoventilaition
- acidotic
- careful ox therapy - NIV (bipap)
- may see headahce, tachy, tremor/flap, bouding pulse
asthma mgmt
1) saba
2) +steroid
3)+laba (continue if benefitial)
inc steroid to 800
consider other options (luek, theoph)
4) steroid to 2000
5) oral steroid
Inhalers
Symbicort - budesonide + formeterol
- turbohaler
Seretide - purple mdi
- fluticasone + salmeterol
Spiriva= tiotroprium
asthma attack
severe vs life threat
SEVERE
pulse >110
resp>25
pefr 33-50%
LIFE THREAT
silent chest, cyanosis, bradycard
pef<33%
confusion, exhaustion
asthma attack initial mgmt
100% O2 (15L nrb)
nebs: iprat (0.5mg) and salb (5mg)
steroids: iv hydro (100mg) +/- pred (40mg)
do cxr
asthma attack treat (early)
O SHIT ME
100% O2 (15L nrb)
Salbutamol 5mg neb (back to back)
Ipratroprium 0.5mg neb
Hydrocortisone 100mg IV +/- prednis 40mg po
do CXR (rule out pn.th)
life threat: IV mg sulfate 1.2g iv over 20mins
escalate ?ICU
Samters triad
Asthma
Aspirin sensitivity
Polyps
eosinophilic asthma
abpa
churg strauss
abpa
main type of ‘eosinophilic asthma’
type 1 and 3 (IgG) hypersens
early bronchoconst, recurrent pneumonia,
eventual bronchiectasis
upper lobe fibrosis
sputum, skin test
eosinophilia, IgE
T: prednisolone, bronchodilat
abpa
main type of ‘eosinophilic asthma’
type 1 and 3 (IgG) hypersens
early bronchoconst, recurrent pneumonia,
eventual bronchiectasis
upper lobe fibrosis
sputum, skin test
eosinophilia, IgE
T: prednisolone, bronchodilat
PE Wells Score
general risks:
- immob, surgery
- thrombophilia
- malig
- oestrogen - hrt, pil, preg
DVT suspicious 3
alt diag less likely 3
tachycardia 1.5
hx immob or sugery 1.5
previous 1.5
haemoptysis 1
malignancy 1
blood gas in PE
ecg in PE
resp alkalosis
tachy, rbbb/rad, s1,q3,t3 (rare)
PE Mx
over 4 points
CTPA
under 4 points d dimer then ctpa if positive
ecg S1,Q3,T3
tachy, RBBB
PE Mx
over 4 points
CTPA
under 4 points d dimer then ctpa if positive
ecg S1,Q3,T3
tachy, RBBB
COPD exacerbation
give prednis and abx
if consolidation present likely strep pne
if no conolidation haemoph inlf
if frequent then keep pred and abx at home
copd diagnosis
ratio under 0.7 post bronchodilator
fev1 determines severity mild >80 mod 50-80 sev 30-50 v sev <30
invest: CXR, FBC (polycyth)
copd: emphys vs chron bronch
chron bronch
- clinical diag
- prod cough 3m, 2y
emphy
- histolog def: enlarged airspaces, destruc of alveolar walls
copd comps
exacerbations - may be infective polychyth cor pulmonale pneumothorax risk carcinoma risk
COPD exacerbation
give prednis and abx
if consolidation present likely strep pne
if no conolidation haemoph inlf
if frequent then keep pred and abx at home
copd treat
stop smoking, vaccines
mild: ipratro/salb prn
mod: regualar tiotr/salm
?inhaled steroid
pulm rehab
LTOT (may inc survival)
copd comps
exacerbations - may be infective polychyth cor pulmonale pneumothorax risk carcinoma risk
restrictive spirometry
FEV1 low but FVC also low
so ratio is normal
causes of interstitial lung disease
occupational casues: coal, silic, abest
extrinsic allergic alveolitis
(upper zone appart from asbest)
drugs: methotrexate, amiodarone etc
(lower zone)
w/ systemic conds
- sle, ra, sarcoidosis, UC
(lower zone apart from sarc)
IDIOPATHIC PULM FIBROSIS
-most common
(lower zone)
idiopathic pulmonary fibrosis
commonest cause of interstitial lung disease
inflam infiltrate and fibrosis