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Z Year 3 Misc > Respiratory emergencies > Flashcards

Respiratory emergencies Flashcards

1
Q

What nerves are involved in resp physiology?

A
  1. Ventral respiratory groups and dorsal respiratory groups which send impulses to diaphragm and intercostal muscles
  2. C3, C4, C5
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2
Q

What questions should be asked with SOB?

A
  • Onset: acute, subacute, chronic
  • Duration
  • Character: air hunger, wheeze
  • Triggers: exertion, exercise, laying flat
  • Night time symptoms: orthopnoea, wheeze, daytime fatigue
  • Exercise tolerance: how far can you walk? MRC breathlessness scale
  • Associated symptoms: cough, wheeze, chest pain, palpitations
  • Social History
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3
Q

What is a tension pnuemothorax?

A

life threatening condition defined as air trapped in pleural cavity under positive pressure, causing cardiopulmonary compromise (air can get in but can’t get out)

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4
Q

What is the treatment for tension pneumothorax?

A
  • Emergency needle decompression
  • High flow oxygen
  • Chest drain
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5
Q

Where is the needle inserted for tension penumothorax?

A

insert into second intercostal space at mid-clavicular line

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6
Q

What is a pulmonary embolism?

A

-venous thrombi that pass into the pulmonary circulation causing occlusion
-normally arise from DVTs
Perfusion mismatch

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7
Q

What are RF for PE?

A
  1. Immobilisation
  2. Malignancy
  3. Recent surgery
  4. HRT/COCP
  5. Thrombophilias
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8
Q

What is gold standard for diagnosing PE?

A

CT pulmonary angiogram

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9
Q

What else can be used to diagnose PE?

A
  1. Ventilation/perfusion Scan (V/Q scan): will demonstrate perfusion defects and a V/Q mismatch (if preggers so can’t have CT)
  2. Using scoring tools to help your diagnosis e.g. Wells score and Geneva score
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10
Q

What is the management of a PE if they are haemdynamically unstable?

A
  1. Call for help
  2. Oxygen, fluids
  3. Admit for urgent thrombolysis: local or systemic
  4. Or percutaneous embolectomy
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11
Q

What is the management of PE if not haemodynamically unstable?

A

Risk stratification:

  1. Hestia score
  2. PE severity index (PESI)
  3. Simplified pulmonary embolism severity index (sPESI)
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12
Q

What is the management of PE if moderate to high risk?

A
  1. Admit to hospital + commence LMWH

2. Give oxygen if hypoxic

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13
Q

What is the management of PE if low risk?

A
  1. Discharge with high dose LMWH (cancer) or DOAC and warfarin for 3 months and outpatient follow up for monitoring
  2. If unprovoked, investigate cause
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14
Q

What may you see on the X ray in pulmonary oedema?

A 
A- alveolar oedema (bat wing opacities)
B- Kerley B lines
C-cardiomegaly 
D- dilated upper lobe vessels 
E-pleural effusion
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15
Q

What is acute pulmonary oedema?

A

Defined as accumulation of fluid within the lung parenchyma, resulting in impaired gaseous exchange

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16
Q

What are causes and examples of acute pulmonary oedema?

A
  1. Cardiogenic: heart failure, arrhythmia, MI
  2. Renal: acute, serve kidney failure
  3. ARDS: caused by lung injury e.g. infection (COVID)
    Different causes may mean different treatment approaches - treat the cause
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17
Q

What is the management of acute cardiogenic pulmonary oedema?

A
  • ABCDE and position upright
    1. Give oxygen if hypoxic
    2. High dose IV diuretics: furosemide bolus
    3. Treat cause e.g. beta blockers for arrhythmia
    4. Re-assess
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18
Q

What happens if they improve for this intial treatment of acute cardiogenic pulmonary oedema?

A
  1. Regular diuretics
  2. Fluid restriction
  3. Daily weight: lose 1kg a day (1L)
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19
Q

What happens if they do not improve for this intial treatment of acute cardiogenic pulmonary oedema?

A
  1. Consider nitrate infusion (e.g. GTN) if systolic BP>100mmhg
  2. If not work consider CPAP (recruits alveoli and drives fluid out of alveolar spaces)
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20
Q

What is asthma?

A

Chronic, inflammatory airway disease characterised by reversible airways obstruction

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21
Q

What is the defintion of a moderate asthma attack?

A
  1. PEF at 50-75% of best or predicted

2. No signs of severe asthma

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22
Q

What is the definition of severe asthma attack?

A
  1. PEF at 33-50% of best or predicted
  2. Respiratory rate >25/min
  3. Heart rate >110/min
  4. Inability to complete sentences in one breath
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23
Q

What acronym is used to find out about life threatening asthma?

A

CHEST

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24
Q

What are components of CHEST?

A
  1. Cyanosis: SpO2<92%, PaO2<8kPA
  2. Hypotension
  3. Exhaustion: poor inspiratory effort, confusion, normal PCO2
  4. Silent chest
  5. Tachy-/brady- arrhythmias
25
What is the initial management of life threatening asthma attack?
1. Oxygen: aim sats 98% 2. Bonchodilators: salbutamol +/- ipratropium, IV magensium 3. Steroids: PO prednisolone/IV hydrocortisone 4. RE ASSESS
26
What should you do next if they improve from the intial mangement of asthma attack?
1. Continue bronchodilators, steroids (5-7days), Wean O2 2. Serial PEF: discharge if PEF>75% 3. TAME asthma (technique, avoid triggers, monitor PEF, educate)
27
What should you do next if they do not improve from the intial mangement of asthma attack?
1. Call for help -> ITU?HDU 1. Oxygen: aims sats 98% 2. Bonchodilators: salbutamol +/- ipratropium, IV magensium 3. Steroids: PO prednisolone/IV hydrocortisone 4. RE ASSESS
28
When do you involve ITU for asthma?
1. Acute severe or life threatening asthma, who is not responding to treatment 2. Requiring ventilatory support
29
How can ITU/HDU help with asthma attack?
1. High flow oxygen: (optiflow), deliver O2 up to 60L/min | 2. Ventilation: non-invasive or invasive
30
What is cough?
defence reflex mechanism to rid the airway of noxious compounds
31
What are the 3 phases of cough?
1. Inspiratory phase 2. Forced expiratory effort against a closed glottis 3. Opening of the glottis, with subsequent rapid expiration that generates a characteristic cough sounds
32
What questions should you ask for cough?
- Onset: acute, chronic (>8weeks) - Character: dry, productive - Triggers: exertion, laying flat - Exercise tolerance: how far can you walk? MRC breathlessness scale - Associated symptoms: breathlessness, fever - Drug history - Social History: smoking, travel
33
What is community acquired pneumonia?
acute lower respiratory tract infection associated with fever and chest signs
34
What would auscultation show in CAP?
1. coarse crepitations 2. dullness to percussion 3. increased vocal fremitus
35
What are most common pathogens in CAP?
1. strep pneumoniae 2. haemophilius infeluzenae 3. morazella cattarhalis
36
What are normal atypical pathogens in CAP?
1. mycoplasam 2, chlamydia psitasittis 3. legionella
37
What is the management of CAP?
1. ABCDE 2. Assess severity 3. CURB65
38
What does CURB65 stand for?
``` C: confusion AMTS <8 U: urea>7 R: resp rate>30bpm B: systolic BP <90mmHg 65: age >65 ```
39
When CURB65 is over 3 what is mortality?
high mortality up to 40%, senior review/itu
40
What are some RF for bronchiectasis?
whooping cough and multiple chest infections in childhood
41
What is bronchiectasis?
permenant dilation of bronchi and/or bronchioles due to chronic inflammation
42
What are 3 types of bronchiectasis?
1. cylindrical 2. cystic 3. varicose
43
What are congenital causes of bronchiectasis?
1. CF 2. primary ciliary dyskineasia 3. Young's syndrome
44
What are aquired causes of bronchiectasis?
1. Post infection 2. Aspergillosis (ABPA) 3. inflammatory disease (RA, UC)
45
What is gold standard investigation for bronchictasis?
HRCT
46
What blood are investigated for bronchictasis?
1. immunoglobulins 2. HIV 3. FBC 4. autoimmune screen
47
What is the spriometry result for obstructive?
obstructive pattern
48
What is sputum culture like in bronchiectasis?
commonly grown pseudomonas
49
What is the conservative management for bronchiectasis?
chest physio (airway clearance techniques)
50
What is the medical management for bronchiectasis?
1. mucolytics 2. ABx 3. inhaled steroids and bronchodilators 4. Itraconazole (ABPA)
51
What is the surgical management for bronchiectasis?
indicated only in severe localised disease or with haemoptysis
52
What does ACE do?
involved in breaking down bradykinin
53
Why do you get ACE inihbitor cough?
caused by accumulation of bradykinin and prostaglandins, which directly sensitise cough receptors
54
How common is ACEi cough?
15% of patients on an ACEi develop a chronic irritant cough
55
What are resp tests like in PF?
Low FEV1/FVC Small lung capacity Restirctive lung disease
56
How does pulmonary fibrosis show on imaging?
1. sometimes PF shows up sometimes on XRAY and it doesn't 2. honeycomb on CT 3. biopsy diagnose
57
What is mesothelioma?
1. malignancy of mesothelial cells that form the pleural lining 2. insidious onset 3. linked with asbestos exposure
58
What are investigations for mesothelioma?
1. X ray: CXR, CT chest | 2. Surgery: video assisted throacoscopic surgery
59
What is management of mesothelioma?
1. Pallative: surgical resection, chemotherapy, radiotherapy 2. Pallitative care involvement 3. Finanacial: can claim compensation due to asbestos exposur

Z Year 3 Misc (11 decks)

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