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GAP 2018 > Respiratory CPGs > Flashcards

Respiratory CPGs Flashcards

1
Q

Definition of Asthma

A

An episodic, reversible chronic obstructive pulmonary disease of lower airways characterised by inflammatory hyperresponsiveness to stimuli including bronchospasm, mucous plugging and mucosal oedema

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2
Q

Patho of Asthma

A
  1. trigger
  2. mast cell degranulation and inflammatory mediator release
  3. increased vascular permeability
  4. mucous production, mucous plugging, bronchospasm
  5. gas trapping
  6. hyperinflation of chest
  7. increased intrathoracic pressure
  8. impedes venous return via vena cava
  9. reduced cardiac output
  10. PEA arrest
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3
Q

Asthma triggers

A

Pollution
Infection
Exercise
Drugs

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4
Q

Effects of reassurance and position on Asthma mx

A
  • reduce anxiety, reduce catecholamine release, reduce HR, RR, BP
  • reduce WOB by allowing best use of accessory muscles
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5
Q

Effects of O2 on Asthma mx

A

increase partial pressure of o2 delivery to ischaemic tissues

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6
Q

Effects of Salbutamol on Asthma mx

A

bronchodilation leads to increased ventilation

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7
Q

Effects of Dexamethasone on Asthma mx

A

stabilises mast cells leads to relief of inflammatory reactions - provides immunosuppression

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8
Q

Effects of Atrovent on Asthma mx

A

bronchodilation - blocks vagal tone

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9
Q

Effects of Adrenaline on Asthma mx

A

alpha: vasoconstriction, increased VR and CO
B1: increased contractility of heart leads to increase CO to overcome ITP
B2: bronchodilation reduces gas trapping - assist to stabilise mast cells

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10
Q

Effects of apnoea on asthma mx

A

Allows passive exhalation of trapped gas

Reduces ITP to increase VR and CO

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11
Q

COPD definition

A

A term used to describe a number of lung conditions that are long-term and cause SOB due to a reduction in air flow through the airways.

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12
Q

Bronchitis definition

A

constant inflammation of bronchi caused by irritants characterised by increased number and size of mucous producing glands, productive cough >3months for 2 consecutive years.

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13
Q

Emphysema definition

A

destruction and irreversible enlargement of the airways distal to the bronchioles accompanied by destruction and collapse of the alveoli

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14
Q

Signs and symptoms of bronchitis

A
  • chronic productive -cough
  • wheeze
  • dusky/cyanotic colour - blue bloaters
  • hypoxia
  • normal/overweight
  • digital clubbing
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15
Q

Signs and symptoms of emphysema

A
  • tachypnoea
  • increased CO2 -retention (pink)
  • pursed lip breathing
  • barrel chest
  • prolonged expiratory
  • use of accessories
  • thin build
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16
Q

Signs and symptoms of COPD Exacerbation

A

Increased dyspnoea
Increased cough
Increased sputum production
* complete removal of wheeze may not be possible in these pts*

17
Q

Patho of bronchitis

A
  • inspired irritants
  • increased mucous production and mucous gland hypertophy
  • impaired ciliary function (lungs defence mechanisms compromised making them susceptible to infection)
  • reduced mucous clearance
  • bronchial walls become inflamed and oedematous
  • airway obstruction/narrowed lumen
  • airflow limitation
  • reduced alveoli ventilation
  • V/Q mismatch
18
Q

Patho of emphysema

A
  • destruction of alveolar septa (breakdown of elastin within the septa by proteases)
  • loss of elastic recoil
  • reduced volume of air that can be passively expired
  • hyperinflation of alveoli
  • produces large air spaces
  • part of each inspiration becomes trapped
  • reduced ventilation and perfusion
19
Q

Suspect COPD in pts over 40 with:

A
  • smoking hx
  • dyspnoea that is progressive, persistent and worse with exercise
  • chronic cough
  • chronic sputum production
  • family hx
20
Q

Definition of pneumonia

A

infection of lower resp tract (lung parenchyma) causing inflammation, alveolar exudates, consolidation

21
Q

Patho of pneumonia

A
  • aspiration of oropharyngeal secretions or strep
  • adhere to alveolar macrophages: exposure of cell wall components
  • inflammatory response: attraction of neutrophils, release inflammatory mediators, accumulate fibrous exudates, RBCs and bacteria
  • red hepatisation and consolidation of lung parenchyma
  • leukocyte infiltration
22
Q

Definition of PE

A

occlusion of pulmonary vasculature by thrombus, tissue fragment, fat or air

23
Q

Patho of PE

A
  • venous stasis, vessel injury, coagulopathy
  • dislodgment of portion of thrombus
  • occlusion of part of pulmonary circulation
  • hypoxic vasoconstriction, reduces surfactant, release of neurohumeral and inflammatory substances, pulmonary oedema, atelectasis
  • V/Q imbalance, reduces pao2, reduced CO, hT, shock
24
Q

Hyperventilation definition

A

Alveolar ventilation exceeds metabolic demands, lungs remove co2 at a faster rate than it is metabolised causing decreased co2

25
Q

Hyperventilation patho

A
  • Increased RR causes alveolar hyperventilation and reduced pco2
  • increased pH within minutes (alkalosis)
  • cellular buffers provide immediate compensation with shifts of H from ICF to ECF
  • increased affinity of o2 to Hb. Hb does not release o2 causing reduced tissue perfusion
26
Q

Management of mild/mod distress in Asthma for adults

A

Salbutamol pMDI and spacer - 4-12 doses at 20 min intervals until resolution of symptoms
-pt take 4 breaths per dose

27
Q

Management of severe resp distress in asthma for adults

A
  • Salbutamol 10mg and Atrovent 500mcg neb
  • repeat Salbutamol 5mg every 5 mins
  • Dexamethasone 8mg IV/oral
28
Q

Management of adults asthma pts with inadequate response to nebulised therapy

A
  • Adrenaline 500mcg IM -repeat at 5-10min intervals (max 1.5mg)
  • if no response, consult the clinician for 20mcg IV Adrenaline every 2 mins
29
Q

Mx of adult asthma who becomes unconscious with poor/no ventilation

A
  • Ventilate at 6-7ml/kg 5-8 ventilations per min
  • moderately high resp pressures
  • allow for prolonged expiratory phase
30
Q

mx of adult asthma who loses CO

A
  • apnoea 1 min

- prepare for resus

31
Q

Mx of COPD

A

Salbutamol 10mg and Atrovent 500mcg neb

Dexamethasone 8mg IV/oral

GAP 2018 (13 decks)

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