Respiratory Flashcards
How should primary PTX be managed?
if the rim of air is < 2cm and the patient is not short of breath then discharge should be considered
otherwise, aspiration should be attempted
if this fails (defined as > 2 cm or still short of breath) then a chest drain should be inserted
patients should be advised to avoid smoking to reduce the risk of further episodes - the lifetime risk of developing a pneumothorax in healthy smoking men is around 10% compared with around 0.1% in non-smoking men
How should secondary PTX be managed?
Recommendations include:
if the patient is > 50 years old and the rim of air is > 2cm and/or the patient is short of breath then a chest drain should be inserted.
otherwise aspiration should be attempted if the rim of air is between 1-2cm. If aspiration fails (i.e. pneumothorax is still greater then 1cm) a chest drain should be inserted. All patients should be admitted for at least 24 hours
if the pneumothorax is less the 1cm then the BTS guidelines suggest giving oxygen and admitting for 24 hours
regarding scuba diving, the BTS guidelines state: ‘Diving should be permanently avoided unless the patient has undergone bilateral surgical pleurectomy and has normal lung function and chest CT scan postoperatively.’
Normal PaCO2 in an asthma attack is…
Life-threatening. A normal PaCO2 in an acute asthma attack indicates exhaustion and should, therefore, be classified as life-threatening
What is the Centor Criteria? What is it used for?
The Centor criteria* are as follows:
- presence of tonsillar exudate
- tender anterior cervical lymphadenopathy or lymphadenitis
- history of fever
- absence of cough
If 3 or more of the 4 Centor criteria are present there is a 40-60% chance the sore throat is caused by Group A beta-haemolytic Streptococcus
What is a major feature of aspergillosis?
Eosinophilia is a feature of allergic bronchopulmonary aspergillosis
Define mild, moderate and severe asthma in terms of PEF
Mild - 50-75%
Moderate - 33-50%
Severe - <33%
Up to how many salbutamol puffs can you take in an asthma exacerbation (and how often)
10 puffs (every 30-60 seconds)
Which questionnaire can be used to assess the severity of a patient’s asthma?
Asthma Control Test (ACT)
Definition of COPD
FEV1/FVC <0.7 post-bronchodilator - non reversible
Oxygen saturations in a CO2 retainer
88-92%
Class. Tiotropium
LAMA
Class. Ipratropium
SAMA
Class. Salmeterol
LABA
Which questionnaire can be used to assess the severity of a patient’s COPD?
COPD Assessment Test (CAT)
Diagnosis of obstructive sleep apnoea
Initial: Epworth Sleepiness Scale
11-12 mild
13-15 moderate
16-24 severe
> 10 refer for polysomnography
Definition of pneumonia
signs and symptoms of respiratory infection with CXR confirmation
Definition of Hospital Acquired Pneumonia
hospital in the last 10 days or in-patient for >5 days plus signs and symptoms of respiratory infection with CXR confirmation
Severe CAP treatment
IV Co-amoxiclav and PO Doxycycline (or IV Levofloxacin as monotherapy for penicillin allergic)
Severe HAP treatment
IV Amoxicillin and Gentamicin (or Co-trimoxazole and Gentamicin if penicillin allergic) –> step down to PO Co-trimoxazole
Non Severe Aspiration Pneumonia
PO Amoxicillin and Metronidazole (or PO Doxycycline and Metronidazole for penicillin allergic)
Severe Aspiration Pneumonia
IV Amoxicillin + Metronidazole + Gentamicin (If penicillin allergic swap amox with PO Doxycycline or IV Clarithromycin) –> Step down to PO Amoxicillin and metronidazole (swap amoxicillin with doxycycline if penicillin allergic)
Causes of bronchiolitis
RSV, metapneumovirus (2001)
Causes of croup
parainfluenza type 1 or 3
pH of infective pleural tap
<7.2
