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Yr 3 Medicine Resp > Respiratory Emergencies > Flashcards

Respiratory Emergencies Flashcards

1
Q

What sort of individual experiences anaphylaxis?

A

Sensitised individual is exposed to a specific antigen

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2
Q

What sorts of things commonly cause anaphylaxis?

A

Insect bites/stings, food, medications

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3
Q

What is the immunological response in anaphylaxis?

A

IgE -> Antigen -> Mast cell and basophils -> Increased histamine -> Body response

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4
Q

Over what period of time does anaphylaxis occur?

A

Minuted

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5
Q

Symptoms and signs of anaphylaxis

A

Pruritis, urticaria, angioedema, hoarseness, progressing to stridor and bronchial obstruction, wheeze and chest tightness due to bronchospasm

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6
Q

Treatment of anaphylaxis

A

Remove trigger, maintain airway, 100% oxygen
IM adrenaline 0.5mg repeated every 5 min as needed
IV hydrocortisone 200mg
IV chlorpheniramine 10mg
Bronchospasm -> NEB salbutamol
Laryngeal oedema -> NEB adrenaline

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7
Q

In anaphylaxis, what dose of adrenaline should be given?

A

0.5mg

Repeat every 5 min

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8
Q

In anaphylaxis, what does of hydrocortisone should be given?

A

200mg

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9
Q

In anaphylaxis, what dose of chlorpheniramine should be given?

A

10mg

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10
Q

Define MILD asthma

A

No features of severe asthma

PEFR >75%

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11
Q

Define MODERATE asthma

A

No features of severe asthma

PEFR 50-75%

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12
Q

Define SEVERE asthma

A

PEFR 33-50%
Cannot complete sentences in one breath
Respiratory rate >25/min
HR >110bpm

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13
Q

Define LIFE THREATENING asthma

A

PEFR <33%
Sats <92@ or ABG pO2 <8kPa
Cyanosis, poor respiratory effort, near or fully silent chest
Exhaustion, confusion, hypotension or arrhythmias
Normal pCO2

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14
Q

Define NEAR FATAL asthma

A

Raised pCO2

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15
Q

What is the management for acute asthma?

A 
ABCDE 
Aim for SpO2 94-98%
ABG if sats <92%
5mg nebulised salbutamol (can repeat after 15min) 
40mg oral prednisolone STAT 
(IV hydrocortisone if PO not possible)
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16
Q

What is the management for severe asthma?

A

Nebulised ipratropium bromide 500 micrograms

Consider back to back salbutamol

17
Q

What is the management for life threatening/near fatal asthma?

A

Urgent ITU assessment
Urgent portable CXR
IV aminophylline
Consider IV salbutamol if nebulised route ineffective

18
Q

What are the 2 types of COPD exacerbation?

A

Infective

Non-infective

19
Q

What things could indicate an infective COPD exacerbation?

A

Change in sputum volume/colour
Fever
Raised WCC +/- CRP

20
Q

How should a COPD exacerbation be managed?

A 
Oxygen 
NEBs - salbutamol and ipratropium 
Steroids - prednisolone 30mg STAT, OD 7 days 
Antibiotics if indicated 
CXR 
Consider IV aminophylline 
Consider NIV if type 2 resp failure and low pH 
ITU referral if pH <7.25
21
Q

How should oxygen therapy be delivered in an exacerbation of COPD?

A

Via a fixed performance face mask due to risk of CO2 retention
Aim for sats of 88-92% guided by ABG

22
Q

How can pneumonia be diagnosed?

A

Consolidation on CXR with fever

+/- purulent sputum +/- raised WCC/CRP

23
Q

What tool can be used to identify pneumonia?

A

CURB-65

24
Q

What is CURB-65?

A 
Confusion (MMT 2 or more)
Urea >7 
RR >30/min
BP <90mmHg systolic or <60mmHg diastolic 
65
25
Q

What is the definition of massive haemoptysis?

A

> 240mls in 24hrs

or >100 mls/day over consecutive days

26
Q

What is the management of massive haemoptysis?

A 
ABCDE
Lie patient on side of suspected lesion 
Oral tranexamic acid 5 days IV
Stop NSAIDs/aspirin/anticoag
Antibiotics if infection 
Consider Vit K
CT aortagram
27
Q

What features may be present in a patient with a tension pneumothorax?

A

Hypotension
Tachycardia
Deviation of trachea away from side of pneumothorax
Mediastinal shift away from pneumothorax

28
Q

What is the management of a tension pneumothorax?

A

Large bore cannula into 2nd ICS MCL

Then chest drain to affected side

29
Q

What are some symptoms of PE?

A

SOB
Pleuritic chest pain
Haemoptysis
Low CO then collapse

30
Q

Name some major risk factors for PE

A

Surgery: abdo/pelvic, knee/hip replacement, ITU admission
Obstetric: Late pregnancy, caesarian section
Lower limb: fracture, varicose veins
Malignancy: abdo/pelvic/metastatic
Reduced mobility
Previous proven VTE

31
Q

What is the management of PE?

A 
ABCDE 
Oxygen if hypoxic 
Fluid resuscitation 
Thrombolysis if massive PE - confirm on ECHO or CT 
Anticoag
32
Q

What may you see on CT/ECHO in a patient with a massive PE?

A

Right heart strain

33
Q

How can thrombolysis contraindications be grouped?

A

Absolute

Relative

34
Q

What are some absolute contraindications to thrombolysis?

A 
Haemorrhagic or ischaemic stroke <6months 
CNS neoplasia
Recent trauma or surgery 
GI bleed <1 month 
Bleeding disorder
Aortic dissection
35
Q

What are some relative contraindications to thrombolysis?

A

Warfarin
Advanced liver disease
Infective endocarditis
Pregnancy

36
Q

What are some complications of thrombolysis?

A 
Bleeding 
Hypotension 
Intracranial haemorrhage/stroke 
Allergic reaction 
Systemic embolisation of thrombus
Reperfusion arrhythmias

Yr 3 Medicine Resp (13 decks)

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