Respiratory Conditions Flashcards
Asthma - first aid
First aid
- Sit upright
- Salbutamol MDI 100mcg: 4 puff x 4 times x 4 mins, call 000
- Symbicort: 2 puff then 1 puff thereafter with 4 mins in between. To call 000 after 2nd time if nil response.
Asthma (primary vs. secondary assessment)
Primary assessment
● Mild/moderate: walking and speaking no issues, Sat >94%
● Severe: accessory muscles, unable to complete sentence in 1 sentence, Sat 90-94%
● Life-threatening: altered conscious state, cyanosis, Sat <90%
Secondary assessment
● Mild/moderate: RR <25, HR tachy adult/normal child, sat >94%
● Severe: RR >25, HR tachy, Sat 90-94%
● Life-threatening: RR <8, HR arrhythmia or brady, silent chest, sat <90% or central cyanosis
*Refer to page 55 of GP Study Notes
Asthma ongoing management - Adult
All patients
- Education and asthma action plan
1. SABA PRN only
2. Low dose ICS (regular) + SABA PRN, low dose ICS/LABA PRN
3. Low dose ICS/LABA (daily) +/- ICS/LABA (low dose) or SABA as preventer
4. Mod-high dose ICS/LABA (daily) +/- ICS/LABA (mod dose) or SABA as preventer
5 Refer to specialist
- Refer to page 56 of GP Study Notes
Asthma - assessment of control
Good control (all of) - Daytime symptoms <2 days - SABA <2 days/week - No limitations of activities - No symptoms on waking or at night Partial control (1-2 of) - Daytime symptoms >2 days - SABA >2 days - Any limitation on exercise - Symptoms during night or waking Poor control (3 or more of) - Daytime symptoms >2 days - SABA >2 days - Any limitation on exercise - Symptoms during night or waking
Asthma - acute management (children)
general tips, salbutamol dose, ipratropium dose
General tips - MDI: Start with burst therapy every 20 minutes for the first 1 hour - Nebs: Continuous until improvement - Start oxygen if <95% - Prednisolone within the first 1 hour (1mg/kg for 3-5 days) or methylprednisolone 4mg/kg (100mg max) - Consider Mg if nil improvement (0.1-0.2 mmol/kg, max 10mmol) Salbutamol <6 years ● MDI: 2-6 puffs ● Neb: 2x2.5mg >6 years ● MDI: 6-12 puffs ● Neb: 2x5mg Ipratropium <6 years ● MDI: 4 puffs ● Neb: 250 mcg >6 years ● MDI: 8 puffs ● Neb: 500 mcg
Asthma - ongoing management (children)
1-5 yrs
Education + asthma action plan
1. SABA PRN
2. ICS (low dose) or montelukast as preventer + SABA PRN
3. ICS (low dose) + montelukast, OR ICS (high dose), + SABA PRN
4. Refer to specialist
6-11 yrs
Education + asthma action plan
1. SABA PRN
2. ICS (low dose) or montelukast as preventer + SABA PRN
3. ICS (low dose) + montelukast, OR ICS (high dose) OR ICS/LABA (low dose), + SABA PRN
4. Refer to specialist
Asthma - pregnancy (key points, significant, management approach)
Key points
● Risk of uncontrolled asthma is greater risk to baby than using asthma medications
● Inhaled corticosteroids, beta agonists and montelukast are not associated with foetal abnormalities
● Consider changing to budesonide monotherapy before conception
Significance: Poor control increases risk of pre-eclampsia, preterm delivery and low birth weight.
Management approach: As any other adult with more frequent review.
Bronchiectasis (imaging findings, treatment, causes, Abx indications, management)
Imaging findings: ‘signet ring’
Treatment: Doxycycline 100mg PO BD 10-14 days
Causes:
● Overcrowding leading to increased transmission
● Socioeconomic disadvantage leading to increased difficulty accessing health care
● Lack of access to timely antibiotics for infections
● Low compliance with antibiotic treatment
● Low immunisation rate
When to treat with Abx:
● Increased sputum volume
● Increased purulence
● Increased cough +/- associated symptoms
Management:
● Chest physiotherapy
● Airway clearance
● General measures (health check, immunisations, SNAP)
● Treating infective exacerbations
● Managing haemoptysis
CAP - Adults (CRB-65, Tx, legionella)
CRB-65 (confusion, RR >30, SBP <90, DBP < 60, age 65)
- 0 = home
- 1-2 = consider hospital
- 3-4 = urgent hospital
Treatment:
● Non-severe (0-1): Amoxicillin 1g PO 8 hourly for 5-7 days +/- doxycycline 100mg PO BD
● Severe (2-4): IV ceftriaxone and azithromycin then as above but for a total of 7 days (both amoxicillin +
doxycycline)
Legionella:
● Exposure: cooling systems
● Diagnosis: PCR and urinary antigen test
● Treatment:
○ Low-moderate: azithromycin 500mg PO daily for 3 to 5 days or doxycycline 100mg PO BD for
10-14 days
COPD - severity, stepwise management, preventative
Severity
- Mild: FEV1 60-80%
- Moderate: FEV1 40-59%
- Severe: FEV1 <40%
Stepwise management
- Reduce risk factors
- Optimise function
- SABA/SAMA
- LAMA or LABA or LAMA/LABA
- Consider ICS/LAMA/LABA (trelegy) - Optimise treatment of co-morbidities
- Refer symptomatic patients to rehabilitation
- Initiate advanced care planning
- Manage advanced disease with domiciliary oxygen therapy
Preventative
- Prevenar 13: >70 yrs (non-ATSI)
COPD - oxygen supplementation (goal, eligibility, criteria, air travel)
Goal: 90% saturation during wakefulness.
Eligible: If no smoking > 6 weeks
Criteria:
A. Long-term (>16 hours), baseline ABG
● No pulmonary HTN PO2 =< 55 mmHg
● Pulmonary HTN PO2 =< 59 mmHg
B. During exercise (6MWT) SpO2 < 88%
C. Nocturnal (nocturnal SpO2) SpO1 <89% for > 30% of testing time
D. Air travel (high altitude study test if SpO2 <92% RA) SpO2 <85%
Air travel
● Pts on long-term oxygen = travel with 1-2L of oxygen
● Pts with good exercise capacity >95% = flight is safe, no further evaluation is needed
Hypersensitivity pneumonitis (cause, symptoms, exposure, recovery)
Cause: Environmental trigger with nil infection
Symptoms: fever, chills, malaise, cough, SOB
Exposure: farm, birds, textile workers
Recovery: subsides with removal of exposure
Lung cancer (key point, common symptoms, investigations)
Key point
● Always consider in patients with smoking history with new cough
● CXR does not rule out lung cancer
Common symptoms: cough, haemoptysis, chest pain, dyspnoea
● Cough is common in 50-75% of patients especially for squamous of SCLC due to common involvement of
central airway
Investigation: CT chest
Lung cancer - small cell
Keypoint:
● If there is mediastinal involvement (even without lung mass), there needs to be a suspicion of SCLC
Buzzwords: smoker, central mass (common +++)
Prognosis: poor due to fast doubling time
Pleural effusion - causes
Transudate
- Heart failure
- Nephrotic syndrome
- Liver failure with ascites
- Constrictive pericarditis
- Hypothyroidism
- Ovarian tumour
Exudate
- Infection
- Malignancy
- Pulmonary infarction
- Pancreatitis
