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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
Q

What is the initial management of life threatening asthma attack?

A
  1. Oxygen: aim sats 98%
  2. Bonchodilators: salbutamol +/- ipratropium, IV magensium
  3. Steroids: PO prednisolone/IV hydrocortisone
  4. RE ASSESS
26
Q

What should you do next if they improve from the intial mangement of asthma attack?

A
  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
Q

What should you do next if they do not improve from the intial mangement of asthma attack?

A
  1. Call for help -> ITU?HDU
  2. Oxygen: aims sats 98%
  3. Bonchodilators: salbutamol +/- ipratropium, IV magensium
  4. Steroids: PO prednisolone/IV hydrocortisone
  5. RE ASSESS
28
Q

When do you involve ITU for asthma?

A
  1. Acute severe or life threatening asthma, who is not responding to treatment
  2. Requiring ventilatory support
29
Q

How can ITU/HDU help with asthma attack?

A
  1. High flow oxygen: (optiflow), deliver O2 up to 60L/min

2. Ventilation: non-invasive or invasive

30
Q

What is cough?

A

defence reflex mechanism to rid the airway of noxious compounds

31
Q

What are the 3 phases of cough?

A
  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
Q

What questions should you ask for cough?

A
  • 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
Q

What is community acquired pneumonia?

A

acute lower respiratory tract infection associated with fever and chest signs

34
Q

What would auscultation show in CAP?

A
  1. coarse crepitations
  2. dullness to percussion
  3. increased vocal fremitus
35
Q

What are most common pathogens in CAP?

A
  1. strep pneumoniae
  2. haemophilius infeluzenae
  3. morazella cattarhalis
36
Q

What are normal atypical pathogens in CAP?

A
  1. mycoplasam
    2, chlamydia psitasittis
  2. legionella
37
Q

What is the management of CAP?

A
  1. ABCDE
  2. Assess severity
  3. CURB65
38
Q

What does CURB65 stand for?

A 
C: confusion AMTS <8
U: urea>7
R: resp rate>30bpm
B: systolic BP <90mmHg
65: age >65
39
Q

When CURB65 is over 3 what is mortality?

A

high mortality up to 40%, senior review/itu

40
Q

What are some RF for bronchiectasis?

A

whooping cough and multiple chest infections in childhood

41
Q

What is bronchiectasis?

A

permenant dilation of bronchi and/or bronchioles due to chronic inflammation

42
Q

What are 3 types of bronchiectasis?

A
  1. cylindrical
  2. cystic
  3. varicose
43
Q

What are congenital causes of bronchiectasis?

A
  1. CF
  2. primary ciliary dyskineasia
  3. Young’s syndrome
44
Q

What are aquired causes of bronchiectasis?

A
  1. Post infection
  2. Aspergillosis (ABPA)
  3. inflammatory disease (RA, UC)
45
Q

What is gold standard investigation for bronchictasis?

A

HRCT

46
Q

What blood are investigated for bronchictasis?

A
  1. immunoglobulins
  2. HIV
  3. FBC
  4. autoimmune screen
47
Q

What is the spriometry result for obstructive?

A

obstructive pattern

48
Q

What is sputum culture like in bronchiectasis?

A

commonly grown pseudomonas

49
Q

What is the conservative management for bronchiectasis?

A

chest physio (airway clearance techniques)

50
Q

What is the medical management for bronchiectasis?

A
  1. mucolytics
  2. ABx
  3. inhaled steroids and bronchodilators
  4. Itraconazole (ABPA)
51
Q

What is the surgical management for bronchiectasis?

A

indicated only in severe localised disease or with haemoptysis

52
Q

What does ACE do?

A

involved in breaking down bradykinin

53
Q

Why do you get ACE inihbitor cough?

A

caused by accumulation of bradykinin and prostaglandins, which directly sensitise cough receptors

54
Q

How common is ACEi cough?

A

15% of patients on an ACEi develop a chronic irritant cough

55
Q

What are resp tests like in PF?

A

Low FEV1/FVC
Small lung capacity
Restirctive lung disease

56
Q

How does pulmonary fibrosis show on imaging?

A
  1. sometimes PF shows up sometimes on XRAY and it doesn’t
  2. honeycomb on CT
  3. biopsy diagnose
57
Q

What is mesothelioma?

A
  1. malignancy of mesothelial cells that form the pleural lining
  2. insidious onset
  3. linked with asbestos exposure
58
Q

What are investigations for mesothelioma?

A
  1. X ray: CXR, CT chest

2. Surgery: video assisted throacoscopic surgery

59
Q

What is management of mesothelioma?

A
  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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