Respiratory Emergencies Flashcards
What sort of individual experiences anaphylaxis?
Sensitised individual is exposed to a specific antigen
What sorts of things commonly cause anaphylaxis?
Insect bites/stings, food, medications
What is the immunological response in anaphylaxis?
IgE -> Antigen -> Mast cell and basophils -> Increased histamine -> Body response
Over what period of time does anaphylaxis occur?
Minuted
Symptoms and signs of anaphylaxis
Pruritis, urticaria, angioedema, hoarseness, progressing to stridor and bronchial obstruction, wheeze and chest tightness due to bronchospasm
Treatment of anaphylaxis
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
In anaphylaxis, what dose of adrenaline should be given?
0.5mg
Repeat every 5 min
In anaphylaxis, what does of hydrocortisone should be given?
200mg
In anaphylaxis, what dose of chlorpheniramine should be given?
10mg
Define MILD asthma
No features of severe asthma
PEFR >75%
Define MODERATE asthma
No features of severe asthma
PEFR 50-75%
Define SEVERE asthma
PEFR 33-50%
Cannot complete sentences in one breath
Respiratory rate >25/min
HR >110bpm
Define LIFE THREATENING asthma
PEFR <33%
Sats <92@ or ABG pO2 <8kPa
Cyanosis, poor respiratory effort, near or fully silent chest
Exhaustion, confusion, hypotension or arrhythmias
Normal pCO2
Define NEAR FATAL asthma
Raised pCO2
What is the management for acute asthma?
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)
What is the management for severe asthma?
Nebulised ipratropium bromide 500 micrograms
Consider back to back salbutamol
What is the management for life threatening/near fatal asthma?
Urgent ITU assessment
Urgent portable CXR
IV aminophylline
Consider IV salbutamol if nebulised route ineffective
What are the 2 types of COPD exacerbation?
Infective
Non-infective
What things could indicate an infective COPD exacerbation?
Change in sputum volume/colour
Fever
Raised WCC +/- CRP
How should a COPD exacerbation be managed?
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
How should oxygen therapy be delivered in an exacerbation of COPD?
Via a fixed performance face mask due to risk of CO2 retention
Aim for sats of 88-92% guided by ABG
How can pneumonia be diagnosed?
Consolidation on CXR with fever
+/- purulent sputum +/- raised WCC/CRP
What tool can be used to identify pneumonia?
CURB-65
What is CURB-65?
Confusion (MMT 2 or more) Urea >7 RR >30/min BP <90mmHg systolic or <60mmHg diastolic 65
What is the definition of massive haemoptysis?
> 240mls in 24hrs
or >100 mls/day over consecutive days
What is the management of massive haemoptysis?
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
What features may be present in a patient with a tension pneumothorax?
Hypotension
Tachycardia
Deviation of trachea away from side of pneumothorax
Mediastinal shift away from pneumothorax
What is the management of a tension pneumothorax?
Large bore cannula into 2nd ICS MCL
Then chest drain to affected side
What are some symptoms of PE?
SOB
Pleuritic chest pain
Haemoptysis
Low CO then collapse
Name some major risk factors for PE
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
What is the management of PE?
ABCDE Oxygen if hypoxic Fluid resuscitation Thrombolysis if massive PE - confirm on ECHO or CT Anticoag
What may you see on CT/ECHO in a patient with a massive PE?
Right heart strain
How can thrombolysis contraindications be grouped?
Absolute
Relative
What are some absolute contraindications to thrombolysis?
Haemorrhagic or ischaemic stroke <6months CNS neoplasia Recent trauma or surgery GI bleed <1 month Bleeding disorder Aortic dissection
What are some relative contraindications to thrombolysis?
Warfarin
Advanced liver disease
Infective endocarditis
Pregnancy
What are some complications of thrombolysis?
Bleeding Hypotension Intracranial haemorrhage/stroke Allergic reaction Systemic embolisation of thrombus Reperfusion arrhythmias
