respiratory emergencies Flashcards
what immunological response causes anaphylaxis?
IgE -> antigen -> mast cells and basophils -> histamine increases -> body response
what are the symptoms of anaphylaxis?
- pruritus
- urticaria and angioedema
- hoarseness, progressing to stridor and bronchial obstruction
- wheeze and chest tightness from bronchospasm
how do you treat anaphylaxis?
- remove trigger, maintain airway, 100% o2
- intramuscular adrenaline 0.5mg, repeat every 5 mins as needed to support CBS
- IV hydrocortisone 200mg
- IV chlorpheniramine 10mg
- hypotensive, lie flat and fluid resuscitate
- treat bronchospasm with NEB salbutamol
- treat laryngeal oedema with NEB adrenaline
what are the signs of a life threatening asthma attack?
- peak expiratory flow less than 33% of best
- Sats <92% or ABG pO2 < 8 kPa
- cyanosis poor respiratory effort, near or fully silent chest
- normal pCO2
- exhaustion, confusion, hypotension or arrhythmias
how would you manage an acute asthma attack?
ABCDE approach
aim for sp02 94-98%, ABG if sats <92%
5mg nebuliser salbutamol, can repeat after 15 minutes
40mg oral prednisolone STAT (IV hydrocortisone if PO not possible)
how would you treat a severe asthma attack?
- Nebulised ipratropium bromide 500mg
- consider back to back salbutamol
how would you manage a life threatening/near fatal asthma attack?
- urgent ITU or anaesthetic assessment
- urgent portable CXR
- IV Aminophylline
- consider IV salbutamol if nebuliser route ineffective
what are the types of COPD exacerbations?
- infective = change in sputum volume/colour, fever, raised WCC +/- CRP
- non infective
how would you approach a patient with a COPD exacerbation?
ABCDE approach
- oxygen via fixed performance mask due to risk of CO2 retention
- aim for SaO2 88-92% being guided by ABGs
- NEBs = salbutamol and ipatropium bromide
- steroids - prednisolone 30mg STAT and OD for 7 days
- antibiotics if raised CRP/WCC or purulent sputum CXR
- consider IV aminophylline
- consider NIV if type 2 res failure and pH 7.25-7.35
- If pH <7.25 consider ITU referal
what would indicate pneumonia in a patient?
consolidation on CXR with fever +/- purulent sputum, +/ raised WCC and/or CRP
how would approach a patient with suspected pneumonia?
ABCDE
- any features of sepsis, immediately treat using sepsis pathway
- otherwise treat with antibiotics as per CURB-65 score, local pneumonia guidelines and patient allergies
what is the CURB-65 score?
helps treat pneumonia by scoring the patients symptoms
C = confusion, MMT 2 or more points worse
U = Urea >7.0
R = >/= 30/min
B = <90 mmHg systolic or <60 mm Hg diastolic
65 = above 65 years old
what is massive haemoptysis?
> 240mls in 24hrs
OR
> 100mls/day over consecutive days
how do you manage a massive haemotypsis?
- ABCDE
- lie patient on side of suspected lesion
- Oral tranexamic acid for 5 days or IV
- stop NSAIDs/Asprin/Anti-coagulants
- antibiotics if any evidence of respiratory tract infection
- consider vitamin K
- CT aortogram - interventional radiologist may be able to undertake bronchial artery embolism
what are the signs of tension pneumothorax?
- hypotension
- tachycardia
on CXR
- deviation of trachea away from the side of the pneumothorax
- mediastinal shift away from pneumothorax
how do you treat a tension pneumothorax?
- large bore intravenous cannula into 2nd ICS MCL
- chest drain into affected side
what are the symptoms of a PE?
- pleuritic chest pain
- SOB
- haemoptysis
- low CO followed by collapse (if massive PE)
what are the risk factors for getting a PE?
- post surgically, e.g abdominal/pelvic, knee/hip replacement
- obstetric e.g late pregnancy or c section
- lower limb e.g fracture or varicose veins
- malignancy e.g abdominal/pelvic/advanced/metastatic
- reduced mobility
- VTE
What is the management of a PE?
ABCDE
- oxygen if hypoxic
- fluid resuscitation if hypotensive
- thrombosis if a massive PE is confirmed on echo or CT scan
- patient should be fully anti coagulated
how would you treat a massive PE?
- suspect if hypotensive/imminent cardiac arrest
- signs of right heart strain on CT/Echo
- consider thrombosis with IV alteplase
what are the contraindications of thrombolysis, both absolute and relative?
Absolute
- haemorrhage or ischaemic stroke less than 6 months ago
- CNS neoplasia
- recent trauma or surgery
- GI bleed <1 month
- bleeding disorder
- aortic dissection
relative
- warfarin
- pregnancy
- advanced liver disease
- infective endocarditis
what are the complications of thrombolysis?
- bleeding
- hypotension
- intracranial haemorrhage/stroke-
- repercussion arrhythmias
- systemic embolisation of thrombus
- allergic reaction
