Respiratory Flashcards
Patient with asthma presents with acute breathlessness.
RR 20
Pulse 100
PEFR 65%
What severity is this?
Moderate
Patient with asthma presents with acute breathlessness.
RR 28
Pulse 115
PEFR 40%
They are unable to speak in full sentences.
What severity is this?
Severe
Patient with asthma presents with acute breathlessness.
They are becoming exhausted with reduced respiratory effort.
What is the PEFR?
< 33%
Patient with asthma presents with acute breathlessness.
They are becoming exhausted with reduced respiratory effort.
What would you expect the heart rate and blood pressure to be?
Bradycardia (<60)
Hypotensive
Patient is regularly using their Salbutamol inhaler. What is the next step in treatment?
Assess inhaler technique.
Add low dose ICS e.g. Beclometasone
Asthma poorly controlled with Salbutamol and Beclometasone inhalers.
What is the next step in treatment?
Assess inhaler technique.
Add LABA e.g. Salmeterol (combined ICS + LABA inhaler)
Asthma poorly controlled using Salbutamol and Beclometasone/Salmeterol inhalers.
Salmeterol has recently been added and has had no effect.
What is the next step in treatment?
Assess inhaler technique.
Stop Salmeterol
Increase dose of beclometasone
Asthma poorly controlled using Salbutamol and Beclometasone/Salmeterol inhalers.
Salmeterol has improved symptoms but there are still problems.
What is the next step in treatment?
Assess inhaler technique.
Increase dose of beclometasone
Asthma poorly controlled using Salbutamol and Beclometasone/Salmeterol inhalers.
Beclometasone has recently been increased.
What is the next step in treatment?
Assess inhaler technique.
Referral to specialist care.
Add a 4th drug e.g. LTRA such as Monteleukast
When is oral steroid treatment indicated in management of asthma?
Addition of 4th drug such as Monteleukast has not sufficiently managed asthma.
Management of Acute Asthma
15L O2 through non rebreather mask
Inhaled Salbutamol (Nebs if life threatening)
Steroids - PO Prednisolone or IV hydrocortisone
MgSO4 if ineffective
Definition of Adult Respiratory Distress syndrome
Acute onset
CXR shows bilateral infiltrates
Pulmonary capillary wedge pressure < 19mmHg OR absence of congestive heart failure
Refractory hypoxaemia
Presentation of ARDS
Acute dyspnoea + hypoxaemia Tachycardia Peripheral vasodilation Bilateral fine inspiratory crackles Multiorgan failure
Main infective organisms in bronchiectasis
Haemophilus Influenzae
Streptococcus pneumoniae
Staphylococcus aureus
Pseudomonas Aeruginosa
Causes of Bronchiectasis
Cystic Fibrosis
Allergic Bronchopulmonary Aspergillosis
Post Infectious
Tuberculosis
Kartagener Syndrome - primary ciliary dyskinesia
Mounier Kuhn Syndrome (atrophy of elastic fibres and smooth muscle within the wall of the trachea and main bronchi)
Presentation of Bronchiectasis
Chronic history of productive cough +/- haemoptysis
Coarse inspiratory crepitations
Obstructive picture on spirometry (reduced FEV1 and FVC/FEV1)
Diagnostic Imaging in Bronchiectasis
High resolution CT - Signet ring sign due to thickening of bronchial walls
Management of Bronchiectasis
Pulmonary physio - Airway clearance techniques
Pneumococcal & influenza vaccinations
Smoking cessation
Bronchodilators if comorbid resp disease (Nebuliser helps break up mucus)
Antibiotics - long term if > 3 exacerbations/yr
Mucolytic drugs
Surgery if localised disease
Sail sign
Triangular opacity in posteromedial aspect of lower lobe on CXR
Seen in left lower lobe collapse
Causes of primary pneumothorax
Young, tall, slim men Marfan’s Syndrome Ehlers-Danlos Syndrome Alpha-1 antitrypsin Deficiency Homocystinuria
Causes of secondary pneumothorax
Emphysema Asthma, COPD Pneumocystis Jiroveci Interstitial Lung Disease CF Lung Abscess TB Sarcoidosis Carcinoma
PC of pneumothorax
Asymptomatic if small
Sudden onset dyspnoea +/- chest pain
Examination findings in pneumothorax
Reduced chest expansion
Hyperresonance to percussion
Reduced breath sounds on affected side
If tension pneumothorax: Deviated trachea, distended neck veins, cardiac arrest
Tachycardia and hypotension if severe
Causes of upper zone pulmonary fibrosis
TEAR - TB, extrinsic allergic alveolitis, Ank spond, Radiation
