RESPIRATORY Flashcards
**Acute Asthma Exacerbation
CF: Acute SO, Polyphonic wheeze, hyperinflated chest, mucous productionm increased HR + RR
PERF >50-70% moderate
Life threatening 33 92 CHEST Perf <33, Sp02 < 92%, Cyanosis Hypotension Exhaustion Silent chest Tachycardia
Management: Oxygen 94-98% 15L NRB Salbutamol Nebs hourly Hydrocortisone /ORAL Pred 40mg Ipratropium Bromide Neb Theopyline Magnesium consider Escalate
**Acute Execerbation of COPD
Signs
Treatment
Signs: More coughing, wheezing, or shortness of breath than usual.
Changes in the color, thickness, or amount of mucus.
Treatment: COSI CCAR Controlled Oxygen 28% Venturia Salbutamol 5mg Neb Ipratropium bromide 0.5mg Chest X ray Corticosteroids- Predinsolone 30mg or 200mg IV Hydrocortisone Abx Amox + Doxy + Clarithromycin Resp support Bipap Refer
** Hyperventilation panic attack
- Its main effect is to lower pCO2 and produce a respiratory alkalosis.
•Panic attacks must be associated with >1 month’s duration of subsequent, persisting anxiety about recurrence of the attacks, the consequences of the attacks, or significant behavioural changes associated with them
CF: SOB, pain in chest, paraesthisia, dizziness, perioral tingling, weakness, sweeting
IVX: ABG, ECG to exclude arrythmia
Management: Rebreathing in paper bag to build up pCO2- only when diagnosis certain
relaxation techniques, CBT, SSRI
**Acute Bronchitits
common age group?
CF
symptoms last?
Abx ?
Temporary Inflammation of the bronchi- commonly kids under 5 and often follows a cold
- CF: cough, fever, headache, coryzal, aches and pains
symptoms peak at 2-3 days but cough takes 2-3 weeks to go
Management: paracetemol, ibuprofen, hydration
Antibiotics for babies, >80 and complicated PMH
- Amoxicillin
** Tension Pneumothorax
- One way valve with continual expanding pneumothorax into pleural space, no escape in expiration →mediastinum shifts to C/L hemithorax → compresses great veins → haemodynamic compromise → cardio-respiratory arrest
CF: Acute dyspnoea, Pleuritic chest pain, Haemoptysis
C/L Tracheal deviation, ↑HR, ↓BP, distended neck veins, dizzy, syncope + other signs stated earlier
NO CXR- treat before !!!!
Treatment:
Sit up, 02 15L NRBM, LARGE Bore needle decompression 2nd ICS midclavicular line
Attach Argyl Chest drain post decompression
- you know if its working if its swinging or bubbling
**Pneumonia
cause of CAP?
Syx:
signs:
CURB65 + scores mean?
Severe Abx treatment?
CAP most often strep pneumonia or haemophillus influenza
HAP = been in the last month for 2 days
CF: Fever, rigor, malaise, dyspnoea, cough with purulent sputum, haemoptyisis, pleuritic pain
Signs: Dull percussion and diminished expansion
IVX: CXR, ABG, Bloods, sputum, pleural aspiration for culture
Manage based on CURB-65
Confusion <8 Urea <7 RR <30 BP < 90/60 Age >65 Score 0-1 treat at home 2 hospital 3 > severe pneumonia
Severe:
02, treat hypotension IV fluids
Co-amoxiclav 1.2g/hr
** Pulmonary Embolus
RF major
CF
IVX
Score and what above indicates it is a PE?
ECG changes
Management:
Large
minor
Risk Factors: Major
Recent surgery, Pregnancy/ postpartum, lower limb problems, malignancy, reduced mobility
CF: Acute breathlessness, pleuritic chest pain, haemoptysis, syncope, hypotension, pyrexia, cyanosis, tachycardia, R ventricular heave, dizziness, Gallop Rhythm, DVT
IVX: Bloods D DIMER if low wells score! <4 points PE unlikely
ABG, CXR may be normal or show wedge shape,
ECG RBBB OR R Ventricular Strain
S1, Q3, T3 (inversion)
CTPA
Large: 02, Morphine, immediate thrombolysis
IV access Tinzaparin !!
Major + minor = LMWH HEPARIN with warfarin for 5 days + then WARFARIN for 3 months
Prevention: TED Stockings, stop OCP, if young test for
antiphospholipid. Thrombophillia
Asthma
CF
Diagnostic criteria
Adult stepwise management
CF: Atopy, noctural cough, dyspnoea, recurrent rhinitis, reflux, diurnal variation
Diagnosis:
a) Measure FeNO over ≥ 40
b) +ve Bronchodialtaory reversibility test: improvement post SABA of FEV1/FVC by ≥ 12% AND increase in volume of ≥ 200ml = +ve test
If uncertain of FeNO or Reversibility test, do Ponitor Peak Flow for 2-4 weeks
Adult Stepwise Management;
- Go up ladder if using salb inhaler ≥ 3 doses a week
1) SABA
2) SABA + ICS
3) SABA + ICS + LABA
4) SABA + MEDIUM ICS or LTRA (remove LABA)
5) refer to specialist
COPD
Pink puffer = emphysema
blue bloater = bronchiectasis
Spriometry readings
Management:
1) start
2) non asthmatic features
3) asthmatic features
Add on tx
- Progressive, irreversible obstructive airway disease → chronic bronchitis (cough > 3 months, 2 consecutive years) and emphysema (enlarged alveolar air space)
CF: Productive cough, dyspnoea, polyphonic wheeze, accessory muscles,
IVX:
- Spirometry: <0.7, FEV1/FVC <70%
- CXR, FBC, BMI target 20-25, ABG,
GRADE of breathlessness 1-5
1 = not troubled, 5 = cant leave house
Management
- STOP SMOKING, refer
- Vaccination pneumococal + influenza
- Pulmonary rehabilitation
- Carbocysteine = mucolytic
1). OFFER SABA OR SAMA if need
2). If not asthmatic features –> LABA + LAMA –> then either LABA + LAMA + ICS or if really bad try 3 months but if no use- revert back to LABA and LAMA
3). If ASTHMATIC features –> LABA + ICS –> LAMA + LABA + ICS
Add theophylline if needed
Short term or long term 02 therapy
Rescue packs:
30mg PO Predinisolone 7 days post exacerbation
Abx: Amoxicillin
Bronchodialtor.
Complications: Cor pulmonale
Non-tension Pneumothorax
Primary = spontaneous (young, thin men) due to rupture of subpleural bulla Secondary = often >55yo, smoker, lung pathology on exam or CXR
Pt. may be asymptomatic:
Acute or progressive dyspnoea
Pleuritic chest pain – worse on inspiration or coughing
Laboured breathing
Signs no Tracheal deviation until tension ↓Expansion I/L ↑Resonance I/L ↓Tactile fremitus I/L ↓Breath sounds; ↓Air entry; Pleural rub Cyanosis (severe), may have pyrexia
CXR: Hypodense area w/ loss of vascular markings
Management: 02 15L NRBM
- Bore needle decompression 2nd ICS midclav if >2cm primary, 1-2cm secondary or Immediate chest drain if >2cm secondary
- X-Ray to determine size post-decompression
- If still large (<2cm primary, <1cm secondary) then Chest drain 5th ICS mid-ant axillary
- Determine cause and treat accordingly
Pleural Effusion
CF
Signs
Can be Empyema (pus) Haemothorax, Chylothroax (lymph) or just fluid
CF: Dyspnoea on exertion, pleuritic chest pain, cough
Sign: STONY DULL PERCUSSION, reduced breath sounds on affected side, large effusion –> tracheal deviation
CXR: Small effusions blunt the costophrenic angles, larger ones are seen as water dense shadows with concave upper borders (MENISCUS)
–> Diagnostic aspiration AKA Thoracentesis
Management: Drainage – if effusion symptomatic or surgery if recurrent
Bronchial Carcinoma
Small cell (15%) Rapidly growing and highly malignant = smokers
Non Small Cell
- Squamous = central and local spread early
- Adenocarcinoma = non-smokers “iduno” why i got it
- Large cell = metastasie early
CF: weight loss, clubbing, cough, haemoptysis, chest pain, SOB
Sign: pleural effusion, consolidation
Urgent refer for CXR + 2 week wait
CT scan to stage tumour + cytology
Management: Excision, Chemo + radiotherapy
Lung Sarcoidosis
CF:
Management:
Multisystem chronic inflammatory condition characterised by the formation of non-caseating epithelioid granulomata at various sites in the body.
CF: Bilateral hilar lymphadenopathy, DRY cough, chest pain, decreased exercise tolerance
IVX: ESR, LFT, Ca increased
Stage CXR + tissue biopsy
Management: Steroids
Cystic fibrosis
•Autosomal recessive due to mutations in CFTR gene
CF: Meconium ileus in newborn – bowel atresia
Bronchiectasis, Pancreatic exocrine insufficiency, Raised Na sweat level, crackles, purulent sputum
IVX: sweat test, CXR
Management: Phsyio 3X day, antibiotics, vaccines
Inhailed foriegn body
how to treat infants
children
adults
- If in the larynx, get croupy cough and stridor
- If in bronchus (often R middle or lower lobe), no Sx for a few days until infection, collapse or obstructive emphysema develop
Severe obstruction: Unable to breathe or speak, wheeze, cyanosis
TX
Infants: 5 Back blow and 5 chest thrust
Children: 5 back blow and 5 abdo thust
Adult: 5 back slap and abdo trust- unconscious = CPR
