Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

JR - CardioResp > Respiratory Emergencies > Flashcards

Respiratory Emergencies Flashcards

1
Q

Outline the pathophysiology of anaphylaxis

A

Type I IgE-mediated hypersensitivity reaction

  • First time susceptible individual exposed to allergen, ++ IgE produced - attaches to mast cells
  • Next time exposed, antigen binds to IgE on mast cells - leads to degranulation and hence release of mediators e.g. histamine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

List some effects of systemic release of histamine in anaphylaxis

A

Capillary leakage - low BP - shock
Pruritis/urticaria
Angioedema - hoarseness/stridor
Bronchospasm - wheeze, chest tightness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Outline the immediate management of anaphylaxis

A
  1. A to E including securing airway and giving controlled O2 therapy. Intubate if necessary
  2. Remove cause, e.g. bee stings
  3. Lie flat and raise feet
  4. IM adrenaline 0.5mg (0.5ml of 1:1000). Repeat every 5 mins until BP satisfactory
  5. Secure IV access
  6. IV chlorphenamine 10mg + IV hydrocortisone 200mg
  7. IV fluid bolus
  8. Salbutamol nebs if wheeze
  9. If still hypotensive - ITU, IVI adrenaline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

After your initial stabilisation, how would you further manage anaphylaxis?

A 
Admit for observation (usually HDU)
Monitor ECG
Measure mast cell tryptase 1 - 6 hrs after reaction
Continue chlorphenamine if itchy
Prescribe and demonstrate epipen
Refer to allergy clinic if cause unknown
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the criteria for a mild asthma attack?

A

No features of severe

PEFR >75%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the features of a moderate asthma attack?

A

No features of severe

PEFR 51 - 75%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the features of a severe asthma attack?

A

Any one of the following:

  • PEFR 33 - 50%
  • Cannot complete sentences in 1 breath
  • RR >25/min
  • HR > 110bpm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the features of a life-threatening asthma attack?

A

Any one of the following:

  • PEFR <33%
  • Sats <92% or PaO2 <8kPa
  • Cyanosis/silent chest/poor resp effort
  • Exhaustion/confusion/coma
  • Bradycardia/hypotension
  • Normal or high pCO2
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What denotes a near-fatal asthma attack?

A

Low pCO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How would you manage a severe/life-threatening/near-fatal asthma attack? 5 marks

A

5 of the following points:

  • A to E, and sit them up
  • Salbutamol 2.5mg nebs back to back if needed
  • Prednisolone 40mg PO stat dose
  • Controlled O2 therapy
  • Nebulised Ipratropium bromide 0.5mg
  • Monitor ECG for hypokalaemia
  • Consider IV MgSO4
  • Alert ITU if severe/life-threatening/near fatal
  • Consider IV salbutamol/aminophylline
  • Urgent portable CXR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How would you manage a mild to moderate asthma attack?

A
  • Salbutamol nebs as above

- Prednisolone 30mg PO stat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How would you further manage an asthma attack, following initial emergency treatment?

A

Nebulised Salbutamol 4 hourly
Prednisolone 40mg PO 5- 7 days
O2 to keep sats >94%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the criteria for safe discharge in asthma?

A

Patient must have:

  • Been stable on discharge meds for 24 hours
  • PEFR >75%
  • Had inpatient asthma nurse review - inhaler technique, PEFR meter, written action plan
  • Inhaled steroid and bronchodilator
  • 5 further days oral Pred prescription
  • GP follow-up within 48 hrs
  • Resp clinic f/u within 4 wks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How would you manage a COPD exacerbation?

A
  1. A to E, inc controlled O2 therapy
  2. Nebulised Salbutamol and Ipratropium bromide
  3. Pred 30mg PO stat
  4. Abx if evidence of infection - normally Amoxicillin 500mg PO TDS 5 days
  5. Consider IV aminophylline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

If, following your initial management steps, your pt with an acute COPD exacerbation is still very unwell, what should you do?

A
  1. Consider NIV if RR>30, pH 7.26 - 7.35, or PCO2 rising
  2. Consider I+V if pH < 2.6 and PaCO2 rising despite NIV - ring ITU
  3. Consider resp stimulant drug
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

List 4 investigations you would do for a patient with a COPD exacerbation, and justify each

A
  1. Bloods - FBC, U+E, CRP - ?infection
  2. ABG - ?resp failure
  3. CXR - ?pneumonia
  4. Sputum culture - ?infection
17
Q

How would you initially manage pneumonia?

A
  1. A to E including controlled O2 therapy
  2. Sepsis 6 if features of sepsis
  3. Ix and CURB-65 score
  4. Abx based on CURB-65 score
  5. Analgesia for pain/fever
  6. Consider CPAP if still hypoxic. If hypercapnic, discuss with ITU
18
Q

List 4 investigations you would do for pneumonia

A
  • CXR
  • ABG if sats <92%
  • Bloods - FBC, U+E, CRP, cultures
  • Urine pneumococcal/legionella antigens
  • Pleural fluid aspiration if effusion
19
Q

Outline the CURB-65 score and what that means clinically

A 
Confusion
Urea >7mmol/L
RR>30
BP <90 systolic OR 60 diastolic
Age 65+
0 - 1 = mild - home tx
2 - moderate - admit
3+ - severe - consider ITU
20
Q

Apart from CURB-65 score, what other factors should be considered in someone with pneumonia?

A
  • Underlying resp disease
  • Bilateral/multilobar pneumonia
  • PaO2 <8 or sats <92%
21
Q

What is the definition of massive haemoptysis?

A

> 240ml blood loss in 24 hours, or >100ml/day for 2+ consecutive days

22
Q

How would you manage massive haemoptysis?

A
  1. A to E
  2. Lie pt on side of suspected lesion to prevent blood entering lung
  3. Oral TXA for 5 days
  4. Stop NAIDs/aspirin/warfarin etc
  5. Consider vit K
  6. CT aortogram +/ bronchial artery embolisation
  7. Ix underlying cause
23
Q

List 5 signs of tension pneumothorax

A
  • Tachycardia
  • Hypotension
  • Distended neck veins
  • Tracheal deviation away
  • Respiratory distress
24
Q

How would you manage a tension pneumothorax?

A
  • Large bore IV cannula into 2nd ICS, MCL, at superior border of inferior rib
  • Chest drain
  • CXR
25
Q

List 4 symptoms of PE

A
  • SOB
  • Pleuritic CP
  • Haemoptysis
  • Syncope
26
Q

List 5 signs of PE

A
  • Low BP
  • Raised HR
  • Gallop rhythm
  • RV heave
  • Pleural rub
  • DVT
  • Cyanosis
27
Q

List 4 Ix for PE, and what they might show/why you would do them

A
  • Bloods - FBC, clotting, LFT - underlying cancer/clotting abnormality
  • ECG - sinus tachy, or SI, QIII, TIII
  • CXR - often normal, but may show wedge-shaped infarct if massive PE
  • ABG if hypoxic
28
Q

Which scoring system would you use for someone with a PE?

Outline its criteria

A

Well’s score for PE:

  • Clinical signs/sx of DVT (3)
  • PE is #1 DDx (3)
  • HR>100 (1.5)
  • Immobilisation 3+ days, or surgery in last 4 wks (1.5)
  • Previous VTE (1)
  • Haemoptysis (1)
  • Malignancy treated within last 6 months, or palliative (1)
29
Q

What do a Well’s score of 0-4 and >4 indicate?

A

0 - 4 - PE unlikely - consider doing a D-dimer. If -ve, almost definitely not PE. If +ve, CT-PA.
If >4, no need for D-dimer as PE likely - do CT-PA.

30
Q

What criteria denote a massive PE?

A
  • Hypotension/peri-arrest

- Confirmed signs of RV strain on CT/ECHO (but don’t do scan if peri-arrest obviously)

31
Q

How would you manage a massive PE?

A
  1. A to E inc controlled O2 therapy
  2. Morphine + anti-emetic if in pain or distressed
  3. Consider immediate thrombolysis - 50mg IV alteplase
32
Q

List 5 absolute contraindications to thrombolysis

A
  • Haemorrhagic stroke
  • CNS neoplasia
  • Recent trauma or surgery
  • GI bleed in last month
  • Bleeding disorder
  • Aortic dissection
33
Q

List 5 relative contraindications to thrombolysis

A
  • Warfarin
  • Pregnancy
  • Advanced liver disease
  • IE
34
Q

List 5 possible complications of thrombolysis

A
  • Bleeding
  • Hypotension
  • Anaphylaxis
  • Intracranial haemorrhage/stroke
  • Embolisation of thrombus
35
Q

How should you manage a non-massive PE?

A
  1. A to E
  2. Morphine if in pain
  3. Start heparin (usually LMWH)
  4. If BP >90, start Warfarin regime
  5. If BP <90, start fluids, ITU input and consider norad IVI
36
Q

After your initial stabilisation, how would you further manage a PE?

A
  • TED stockings for further prevention
  • LMWH with warfarin until INR >2, then stop heparin
  • If cause known and reversible, e.g. COCP, warfarin for 6 - 12 wks
  • Otherwise refer to haem, and continue warfarin for 3 - 6 months+

JR - CardioResp (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions