Respiratory emergencies Flashcards
What is virchows triad
Cause of DVT and PE due to factors that lead to clot formation
Endothelial damage
Venous stasis
Hypercoagulability
Risk factors for PE
Immobility / hypercoagulability
- recent surgery
- recent stroke or MI
- disseminated malignancy
- thrombophilia / antiphospholipid syndrome
- prolonged bed rest
- pregnancy / post parfumerie
- COCP
- HRT
- DVT
Symptoms and clinical signs of PE
Acute breathlessness
Pleuritic chest pain
Cough / Haemoptysis
Dizziness / syncope due to lack of oxygen
Fever
Cyanosis
Tachypnoea
Tachycardia
Hypotension
Raised JVP
Pleural rub
Pleural effusion
- signs of DVT or recent surgery
Investigations and investigation findings for PE
PERC score - to confirm if risk is low and can be sent home without diagnostic investigations
CXR - atelectasis and parenchymal densities (may be normal)
ECG - tachycardia, SIQIIITIII pattern, right bundle branch block, right ventricular strain (may be normal)
D - dimer - suggestive but not diagnostic (sign of trying to break down clot)
ABG
CT scan
Ventilation / perfusion scan - VQ perfusion mismatch with low perfusion and normal ventilation
Pulmonary angiogram
Doppler US scan of leg - diagnose DVT
PERC score criteria
O2 stats below 95
Unilateral leg swelling
HR over 100
Recent surgery or trauma
History of DVT or PE
Haemoptysis
Over 50 yrs
Current hormone use (COCP / HRT)
When is D dimer not useful for PE
Recent surgery or trauma
Other auto immune condition
Sickle cell disease
Liver / renal / heart failure
Pregnancy
Sepsis
Acute MI / stroke
PE treatment
Anticoagulation - DOACs (dabigatran, rivaroxiban, apixaban)
Low molecular weight heparin - sub cut injection once daily for prevention
Warfarin - oral
If massive PE
- thrombolytic therapy or surgical pulmonary embolectomy
How to manage bleeding relating to DOAC given for PE
Stop if major bleeding and inform haematologist - haemorrhage control and transfusion
- tranexamic acid
If minor bleed
Check FBC, coagulation screen, renal function and group and save
- TRANEXAMIC ACID
Considerations when giving DOAC from PE
Check dose - depends on weight
Calculate creatinine clearance using Cockcroft gault formula
Annual U+Es, LFTs and Hb
What is pneumothorax
Sudden entry of air into pleural space and the subsequent collapse of the underlying lung
Pneumothorax signs and symptoms
Pleuritic chest pain
SOB
Mediastinal displacement and tracheal deviation towards opposite side
Hyper resnonant percussion
Diminished or absent breath sounds
Reduced or absent vocal resonance
Tinkling crepitations where fluid present (crackling / rattling)
Pneumothorax investigations
Chest X ray
- Assess degree of collapse
- check fluid levels
Difference between tension pneumothorax and pneumothorax
Tension pneumothorax - caused by one way valve between bronchial and pleural space
Pneumothorax- caused by air entry and lung collapse
Tension pneumothorax presentation
Mediastinal shift towards unaffected side - heart also pushed
Clinical diagnosis - emergency - needs immediate treatment or cardiac arrest will occur
Tension pneumothorax treatment
IMMEDIATE ASPIRATION followed by intercostal tube drainage
