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CR3 > Respiratory Emergencies > Flashcards

Respiratory Emergencies Flashcards

1
Q

PE immediate investigation

A

Wells Sore

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2
Q

Which scores on Well’s give 3?

A

Clinical DVT

PE is number 1 diagnosis or equally likely

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3
Q

Which scores on Well’s give 1.5?

A

HR>100
Immobilisation 3 days or surgery in last 4 weeks
Previous PE/DVT

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4
Q

Which scores on Well’s give 1?

A

Haemoptysis

Malignancy with treatment within 6 months or palliative

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5
Q

Well’s score diagnosis how

A

> 4 = PE likely

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6
Q

What to do if Wells score says PE likely?

A
  • admit
  • CTPA
  • LMWH/fondaparinux
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7
Q

What to do if Well’s score says PE unlikely?

A
  • D dimer
  • if positive = admit, CTP, LMWH
  • if negative = consider alternatve diagnosis
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8
Q

CI to porcine based treatments

A

offer fondaparinux instead

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9
Q

Treatment for PE

A
  • LMWH and warfarin

- fondaparinux

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10
Q

How long LMWH for?

A
  • at least 5 days

- or until INR stable

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11
Q

Cancer PE what drugs

A

LMWH alone

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12
Q

Bleeding risk/need surgery in PE what drugs

A

UH

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13
Q

Severe renal failure in PE what drugs

A

UH (measure APTT)

LMWH (measure anti Xa)

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14
Q

Pregnancy PE what drugs

A

LMWH (>3/12 at least 6 weeks post natal)

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15
Q

Tietze syndrome

A
  • very rare
  • inflammatory condition
  • costochondral junction
  • diagnosis of exclusion
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16
Q

Pericarditis

A
  • inflammation of pericardium
  • sudden onset
  • chest, back, shoulders
  • better sitting up
  • worse on inspiration and lying back
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17
Q

Pericarditis on ECG

A
  • PR segment depression
  • widespread concave ST elevation
  • reciprocal ST depression and PR elevation in aVR and V1
  • absence of reciprocal ST depression elsewhere
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18
Q

Spontaneous pneumothorax management

A
  • haemodynamically unstable proceed to chest drain
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19
Q

Secondary pneumothorax define

A

age >50
smoking history
underlying lung disease on exam or CXR

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20
Q

When to chest drain secondary pneumothorax?

A
  • if >2cm or breathes
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21
Q

When to aspirate secondary pneumothorax?

A
  • if 1-2cm

- if not successful and not now <1cm = chest drain

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22
Q

What to do if 2ndry pneumothorax <1-2cm?

A
  • admit
  • high flow oxygen (uncles oxygen sensitive)
  • observe for 24 hours
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23
Q

When to aspirate primary pneumothorax?

A
  • size >2cm and or breathless

- if not success and still >2cm = chest drain

24
Q

When to discharge primary pneumothorax?

A
  • size<2cm
  • not breathless
  • consider discharge in OPD in 2-4weeks
25
What does 1 marijuana joint equate to in cigarettes?
2.5-5
26
How to aspirate pneumothorax?
- aspirate with 16-18G cannula | - aspirate <2.5L
27
Persistent air leak in pnuemothoax
- after chest drain not much improvement - may suggest large bore but no evidence for this - CT scan - never clamp bubbling chest drain!! - consider suction
28
Suction pneumothorax
- low pressure negative suction | - helps appose pleura and allow to heal
29
Video-assisted thoracoscopy
- for persistent air leak post chest drain - stapling of pleura in area of leak - pleurodesis
30
RF of pneumothorax
- tall thin men - cigarette smoking x22 - cannabis - males> - age 15-34 then over 55s
31
2ry pneumothorax causes
``` COPD>> Asthma CT disorder (marfan's) interstitial lung disease (fibrosis) lung infection (TB) CF ```
32
Symptoms of pneumothorax
Sudden onset Pleuritic chest pain SOB
33
Resp differentials of pneumothorax
Pneumonia PE Acute exacerbation
34
Cardiology differentials of pneumothorax
ACS/MI Pericarditis Aortic dissection/aneurysm rupture Cardiac tamponade
35
Signs of pneumothorax
- reduced expansion on that side - hyper-resonant percussion - quiet breath sounds - tachycardia
36
Subcutaneous emphysema
Air underneath skin and can feel it bubbling | If in neck region can cause breathing problems
37
Ix of pneumothorax
CXR ECG (tachy) CT Chest (may just be bubble in lung) FBC
38
Pneumothorax CXR
Lung edge see collapsed No peripheral lung markings around edge Size (>2cm large, hilar point to edge of lung)
39
Pneumothorax Conservative management
- high flow oxygen | - observe and monitor
40
Pneumothorax Medical management
- pleural aspiration - chest drain - suction - medical pleurodesis
41
Surgical Pneumothorax management
- open thoracotomy | - VATS
42
Safe triangle
- lateral edge of pectoralis major - lateral edge of lat dorsi - 5th ICS - base of axillae (above the rib to avoid neurovasc bundle)
43
tension pneumothorax presentation
- severe breathlessness - tachycardia - pulsus paradoxus - distended jugular veins - tracheal deviation - ipsilateral reduced/absent breath sounds
44
Tension pneumothorax tx
- large bore cannula (14G) - 2nd ICS - mid clavicular line - hiss of air as release tension - don't wait for CXR! - needle decompression
45
Advice post pneumothorax
- never dive again - no airplane travel for 2-6 weeks - pregnancy increases risk so monitor - stop smoking
46
Major RF for VTE
``` DVT Previous VTE Immobility Surgery within 2 months (orthopaedic>>) - malignancy (brain cancer) - pregnancy (6w post partum) - lower limb trauma/fracture (THROMBOSIS pneumonic) ```
47
Symptoms of PE
- none - SOB - chest pain (pleuritic) - haemoptysis
48
Signs of PE
- tachypnoea - low grade fever - sinus tachycardia - hypoxia - localised pleural rub - DVT
49
Massive PE Presentation
- may not get pleuritic chest pain, may be central - hypoxia - hypotension, collapse, cardiac arrest, sudden death - acute right heart strain - right heart failure
50
PE Dx
- history and exam - pre test score - CXR (normal?) - ECG (sinus, tachy) - bloods (D dimer) - arterial blood gases - CT pulmonary angiography (gold standard) - V/Q scan(only if CXR normal) - Echo if cannot do CTPA
51
Iconic signs on Dx for PE
- Hampton's Hump Westermark's Sign S1Q3T3
52
Imaging PE when?
- massive within 1 hour - non massive within 24 hours (CTPA gold standard)
53
Pregnancy PE
- Wells and D dimer unhelpful - LMWH - CXR with lead protection for fetus and breast sensitive - ECG - leg US and treat clot there - VQ lower breast cancer risk but childhood cancer risk - CTPA more definitive - no warfarin - DOACs can consider - continue tx at least 6 months post natal
54
PE management
- anticoagulation - thrombolysis (massive, unstable) - rare surgery
55
What is the target INR?
2-3
56
UFH
- bleeding risk - rapid reversal possible - regular blood tests need - rapid anticoagulation

CR3 (30 decks)

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