Respiratory Flashcards by Zi Mistry

severe asthma

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o Respiratory rate >25/min
o Pulse rate >110 beats/min
o Peak expiratory flow 33-50% of predicted/best

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life threatening asthma

o Peak expiratory flow <33% predicted/best
o Silent chest, cyanosis, feeble respiratory effort
o Bradycardia or hypotension
o Exhaustion, confusion or coma
o Increase in pCO2 and this patient is almost dead
WARN ICU

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step 1 asthma mx

inhaled saba prn

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step 2 asthma

saba + low dose ics

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step 3 asthma

saba + ics + laba

if no response to laba, increase ics

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step 4 asthma

increase ics
consider LTRA/theophylline
or beta 2 agonist tablet

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step 5

refer

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acute asthma

nebulised salbutamol +/- ipatropium bromide +O2
iv hydrocortisone
single dose MgSo4 over 20 mins IV

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if asthma attack improving

nebs 4 hourly

pred 5-7 days after

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COPD lifestyle changes

stop smoking
pneumococcal and flu jab
regular lung function assessment

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Stepwise drugs for COPD

SABA , 
LABA + LAMA (if not asthmatic and no steroid responsiveness)
LABA + ICS (if opposite)
LABA + LAMA + ICS
oral theophylline
mucolytic if chronic productive cough

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Acute COPD exacerbation

Increase SABA dose
prednisolone 7-14 days
ABx
IV theophylinne
NIV/Doxapam if unavailable
O2

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NIV indication

persistant hypercapnic ventilator failure in exacerbations

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smoking cessation

NRT
varenicline/bupropoin
support programme

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Bronchiectasis

Postural drainage - physio
Abx + intermittent chemo
if still not working, probs p.aeurginosa
Bronchodilators
Anti inflammatorys
surgery - rare, transplant

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P aeruginosa bronchiectasis

parenteral/ nasal chemo
ceftazidime
ciprofloxacin

CF - lifestyle

MDT
stop smoking
pnemococcal and flu jabs
physio

CF medical

O2 prn
Abx same as bronchiectasis
70% have pseudomonas
SABA + ics for relief
hypertonic saline + DNAse inhalation
Mucolytic
NIV 
treat pancreatic insufficency + malnutrition
lung transplant (+/- heart)

Pneumonia general

O2
IV fluids
Abx
thromboprophylaxis
physio
nutritional supplements
analgesia
cxr 6 weeks later + smoking cessation

low cap

amoxcicillin + doxy

moderate cap

amox and clarithromycin

severe cap

co amoxiclav

clarithromycin/cefuroxime

HAP

o Aminoglycoside IV + antipseudomonal penicillin IV or 3rd gen cephalosporin IV
o If on CCU: Tazocin IV 4.5g tds for 7 days or Meropenem IV 1g tds (not naïve) or Vancomycin IV 1g bd (MRSA)

6 months treatment
2 months Isoniazid + rifampicin, ethambutold, pyrazinamide
4 months Isoniazid + rifampicin

CNS TB

12 months + corticosteroids (same in pericardial)

TB contact tracing

* Household or other close contacts * New entrants from high incidence countries * Immunocompromised * Healthcare workers * Done after diagnosis of a new case of TB * Aim to seek those who may have been exposed to infection and are not yet treated

pneumothorax

decompression 2nd ICS MCV if tension | chest drain in med/large simple pneumothoraces

lung cancer

assess for fitness for treatment surgery (chemo/radio before to shrink) radiation for cure/symptoms chemo in non small cell

lung cancer palliation

laser therapy endobrachial irradiation tracheobronchial stents

pleural effusion

pleural tap pleurodesis surgery

fibrosis

stop smoking steroids Azathioprine or cyclophosphamide added if there’s no response Pirfenidone, an anti-fibrotic anti-inflammatory drug reduces mortality Oxygen therapy is used Lung transplant may be offered in younger patients

extrinsic allergic alveolitis

remove allergen O2 oral pred ``` chronic: prevention avoid exposure facemask long term steroids compensation ```

OSA

correct treatable factors: fat, acromegaly, big tonsils nasal probs, alcohol/sedatives/antidepressants CPAP modafinil

T1RF

o Treat underlying cause o Give oxygen (35-60%) by facemask to correct hypoxia o Assisted ventilation if PaO2 <8kPa despite 60% O2

T2RF

o Remember the respiratory centre may be relatively insensitive to CO2 and respiration could be driven by hypoxia o Treat underlying cause o Controlled oxygen therapy: start at 24% (Note can have up to 15 minutes high flow oxygen, but then must reduce) o Recheck ABG and if PaCO2 is steady or lower, increase the oxygen concentration to 28%. If PaCO2 has risen >1.5kPa and the patient is still hypoxic consider assisted ventilation (e.g. NIPPV). Rarely use a respiratory stimulant (e.g. doxapram 1.4-4mg/min IVI) o If this fails consider intubation and ventilation, if appropriate