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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
Q

What does 1 marijuana joint equate to in cigarettes?

A

2.5-5

26
Q

How to aspirate pneumothorax?

A
  • aspirate with 16-18G cannula

- aspirate <2.5L

27
Q

Persistent air leak in pnuemothoax

A
  • 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
Q

Suction pneumothorax

A
  • low pressure negative suction

- helps appose pleura and allow to heal

29
Q

Video-assisted thoracoscopy

A
  • for persistent air leak post chest drain
  • stapling of pleura in area of leak
  • pleurodesis
30
Q

RF of pneumothorax

A
  • tall thin men
  • cigarette smoking x22
  • cannabis
  • males>
  • age 15-34 then over 55s
31
Q

2ry pneumothorax causes

A 
COPD>>
Asthma
CT disorder (marfan's)
interstitial lung disease (fibrosis)
lung infection (TB)
CF
32
Q

Symptoms of pneumothorax

A

Sudden onset
Pleuritic chest pain
SOB

33
Q

Resp differentials of pneumothorax

A

Pneumonia
PE
Acute exacerbation

34
Q

Cardiology differentials of pneumothorax

A

ACS/MI
Pericarditis
Aortic dissection/aneurysm rupture
Cardiac tamponade

35
Q

Signs of pneumothorax

A
  • reduced expansion on that side
  • hyper-resonant percussion
  • quiet breath sounds
  • tachycardia
36
Q

Subcutaneous emphysema

A

Air underneath skin and can feel it bubbling

If in neck region can cause breathing problems

37
Q

Ix of pneumothorax

A

CXR
ECG (tachy)
CT Chest (may just be bubble in lung)
FBC

38
Q

Pneumothorax CXR

A

Lung edge see collapsed
No peripheral lung markings around edge
Size (>2cm large, hilar point to edge of lung)

39
Q

Pneumothorax Conservative management

A
  • high flow oxygen

- observe and monitor

40
Q

Pneumothorax Medical management

A
  • pleural aspiration
  • chest drain
  • suction
  • medical pleurodesis
41
Q

Surgical Pneumothorax management

A
  • open thoracotomy

- VATS

42
Q

Safe triangle

A
  • lateral edge of pectoralis major
  • lateral edge of lat dorsi
  • 5th ICS
  • base of axillae
    (above the rib to avoid neurovasc bundle)
43
Q

tension pneumothorax presentation

A
  • severe breathlessness
  • tachycardia
  • pulsus paradoxus
  • distended jugular veins
  • tracheal deviation
  • ipsilateral reduced/absent breath sounds
44
Q

Tension pneumothorax tx

A
  • large bore cannula (14G)
  • 2nd ICS
  • mid clavicular line
  • hiss of air as release tension
  • don’t wait for CXR!
  • needle decompression
45
Q

Advice post pneumothorax

A
  • never dive again
  • no airplane travel for 2-6 weeks
  • pregnancy increases risk so monitor
  • stop smoking
46
Q

Major RF for VTE

A 
DVT
Previous VTE
Immobility
Surgery within 2 months (orthopaedic>>)
- malignancy (brain cancer)
- pregnancy (6w post partum)
- lower limb trauma/fracture
(THROMBOSIS pneumonic)
47
Q

Symptoms of PE

A
  • none
  • SOB
  • chest pain (pleuritic)
  • haemoptysis
48
Q

Signs of PE

A
  • tachypnoea
  • low grade fever
  • sinus tachycardia
  • hypoxia
  • localised pleural rub
  • DVT
49
Q

Massive PE Presentation

A
  • may not get pleuritic chest pain, may be central
  • hypoxia
  • hypotension, collapse, cardiac arrest, sudden death
  • acute right heart strain
  • right heart failure
50
Q

PE Dx

A
  • 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
Q

Iconic signs on Dx for PE

A
  • Hampton’s Hump
    Westermark’s Sign
    S1Q3T3
52
Q

Imaging PE when?

A
  • massive within 1 hour
  • non massive within 24 hours
    (CTPA gold standard)
53
Q

Pregnancy PE

A
  • 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
Q

PE management

A
  • anticoagulation
  • thrombolysis (massive, unstable)
  • rare surgery
55
Q

What is the target INR?

A

2-3

56
Q

UFH

A
  • bleeding risk
  • rapid reversal possible
  • regular blood tests need
  • rapid anticoagulation

CR3 (30 decks)

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