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Acute finals > Respiratory emergencies > Flashcards

Respiratory emergencies Flashcards

1
Q

Describe the classification of pneumothorax

A

Traumatic vs spontaneous
Tension
1˚ vs 2˚ (on BG of lung disease)

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2
Q

What are some of the most common causes of secondary pneumothorax?

A

COPD: bullae
Asthma
TB

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3
Q

Describe the classic patient with primary pneumothorax

A

Tall, thin young M

Marfan’s

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4
Q

Describe the presentation of pneumothorax

A
  • Sudden onset sharp pleuritic CP and SOB
  • Haemoptysis
O/E:
-Hypoxia, tachypnoea, tachycardia
-Decreased chest expansion 
-Hyper-resonance to percussion
-Absent breath sounds
\+/- tracheal deviation
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5
Q

Describe the investigations for pneumothorax

A

A to E if acutely unwell
History + examination +obs
-> ECG
-Bloods: FBC, CRP, U+Es, D-dimer, ABG (if unwell)
-CXR (USS if in resus/trauma scan), CT chest for underlying pathology

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6
Q

Describe the CXR findings in pneumothorax

A

-Paucity of lung markings
-Visible lung edge
+/- mediastinal shift

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7
Q

Describe the management of pneumothorax

A

A to E
-High flow O2 if hypoxic

Traumatic: finger thoracostomy + chest drain
Tension: needle decompression in 2nd ICS MCL -> chest drain
Spontaneous and HD unstable/bilateral: chest drain
Spontaneous 1˚:
-Asymp + small: discharge with OPD f/u
->2cm/symp: admit. Aspiration +/- chest drain

Spontaneous 2˚: always need admission for min 24hr

  • Asymp + <1cm: admit and support
  • Asymp + 1-2cm: aspirate +/- chest drain
  • Symp/ >2cm: chest drain
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8
Q

Describe the long-term follow-up/recommendations for pneumothorax

A
  • No flying for 30 days
  • No scuba diving ever
  • Conservative Mx: f/u in 2-4 weeks with CXR for resolution
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9
Q

Describe the risk factors for PE

A

1) Hypercoagulability:
- Malignancy
- COCP/pregnancy
- Nephrotic syndrome
- Dehydration
- Thrombophilia

2) Stasis
- Bed rest/hospitalisation
- Long flights
- Immobilisation
- Surgery

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10
Q

Describe the presentation of PE

A

-Sudden onset sharp pleuritic CP + SOB
-Haemoptysis
-Syncope
+/- DVT: calf pain + swelling

-Tachycardia, tachypnoea, hypoxia, HD unstable

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11
Q

Why is tension pneumothorax dangerous?

A

Increasing size of pneumothorax -> ^^ intrathoracic P

-> decreased venous return -> cardiogenic shock

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12
Q

Describe the investigations for PE

A

A to E

  • IV access and bloods: FBC, CRP, U+Es, *D-dimer, ABG
  • ECG
  • CXR: in all
  • > **CTPA

*Depends on Wells score: <2 D-dimer, >2 CTPA

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13
Q

What are the common + classic ECG changes in PE?

A
  • Most common: no change
  • Sinus tachy
  • Right heart strain: S1Q3T3
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14
Q

Describe the Wells score for PE

A 
Estimates likelihood of PE:
\+3: clinical DVT
\+3: PE most likely Dx
\+1.5: HR >100
\+1.5: immbolisation or recent surgery
\+1.5: previous VTE
\+1: haemoptysis
\+1: malignancy
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15
Q

Describe the management of PE

A

A to E

  • High flow O2
  • Analgesia: morphine + metoclopramide

HD unstable: thrombolysis (alteplase) +/- embolectomy
-Supportive: IV fluids, inotropes

Stable: DOAC (apixaban or rivaroxaban), LMWH (5 days -> dabigatran or warfarin) or unfractionatd heparin

Continue treatment for min 3 months. Consider long-term if unprovoked VTE

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16
Q

Describe the aetiology of ARDS

A

Pulmonary or systemic causes

Pulmonary:

  • Pneumonia
  • COVID
  • Inhalation injury
  • Aspiration

Systemic:

  • Shock
  • Sepsis
  • Pancreatitis
  • Acute liver failure
17
Q

Describe the presentation of ARDS

A

Ill patient -> deterioration

  • Tachypnoea, hypoxia
  • Tachycardia
  • Cyanosis
  • Bilateral fine creps
18
Q

Describe the investigations for ARDS

A
  • Urine
  • Sputum culture + viral screen
  • Bloods: ABG, FBC, CRP, U+Es, LFTs, clotting, culture, amylase/lipase, BNP (rule out HF)
  • CXR (bilateral infiltrates -> white out)
  • Echo (rule out HF)
19
Q

Define ARDS. What are the criteria for diagnosis?

A

Syndrome caused by non-cardiogenic pulmonary oedema and diffuse lung inflammation

1) Acute onset (<1 week)
2) Bilateral opacities on CXR
3) High oxygen requirement/PEEP

20
Q

Describe the management of ARDS

A

A to E

  • Refer to ITU for I+V with low tidal volume -> ECMO
  • Treat cause: sepsis 6 etc
21
Q

Describe the common triggers for anaphylaxis

A
  • Foods: nuts, shellfish
  • Drugs: penicillin, contrast
  • Venom: stings
22
Q

Define anaphylaxis

A

Severe, life-threatening hypersensitivity reaction causing airway, breathing and/or cardiovascular compromise.

23
Q

Describe the presentation of anaphylaxis

A

Sudden onset:

  • Skin rash/hives
  • Facial + oral swelling (angioedema)
  • Stridor
  • Wheeze
  • Tachypnoea, hypoxia
  • Tachycardia
  • Hypotension
24
Q

Describe the investigations for anaphylaxis (non-acute)

A

Investigations may be done after the event to detect allergens:

  • SPT
  • IgE serology / RAST
  • Oral food challenge is gold standard
25
Q

Describe the investigations for anaphylaxis (acute)

A

Do not delay treatment for any investigations:

  • ECG
  • Bloods: mast cell tryptase, U+Es, ABG
  • CXR
26
Q

Describe the management of anaphylaxis

A 
Call for help 
A to E
-Airway: call anaesthetist if obstructed
-Breathing: high flow O2 
-Circulation: IV access, fluids 
-Disability: check glucose

Position patient, stop any infusions
Adrenaline IM 1:1000 500mcg (adults) -> repeat after 5 mins

**New ALS guidelines say only adrenaline necessary
Consider:
-Neb salbutamol 
-IV chlorphenamine 10mg 
-IV hydrocortisone 200mg

-> monitor for 6-12 hours. Discharge with EpiPen, safety-net and f/u appointment in allergy clinic

Acute finals (6 decks)

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