Respiratory emergencies Flashcards
Explain the pathophysiology of anaphylaxis?
IgE reacts with antigen causing mast cell and basophil recruitment and resolvedly histamine release.
Excess histamine release leads to the anaphylactic response.
How would you manage anaphylaxis?
REMOVE THE OFFENDING SUBSTANCE
A to E assessment - establish an airway and start high flow oxygen (15L) via a non rebreather
IM adrenaline - 1 in 1000 (0.5mg)
Hydrocortisone IV - 200mg
Chlorphenamine IV - 10mg
Treat bronchospasm and laryngeal oedema with nebulised salbutamol and nebulised adrenaline.
How would you treat an acute exacberation of COPD?
If infective (increased purulent sputum production, fever, raised WCC +/- CRP) then prescribe antibiotics - eg. Amoxicillin 500mg BD
A to E approach is required
Give oxygen and maintain saturations at a target of 88-92%
Give oral prednisolone 30mg OD and keep giving this for 5 days after acute exacerbation.
Consider IV aminophylline
Consider ITU referral if severe
Order a CXR
What qualifies as a massive haemoptysis?
If the patient has lost more than 240mls in 24 hours
or
> 100mls a day over consecutive days
How would you manage a patient with haemoptysis?
A to E assessment
IV access and group and save if a massive bleed
Lie the patient on the side of the lesion if known
Prescribe antibiotics if a chest infection is suspected
Oral Tranexamic acid for 5 days or IV if this is not feasible
Consider vitamin K
CT aortogram
How does a tension pneumothorax present?
Hypotensive
Tachycardia
Deviation of the trachea away from the side of the pneumothorax on a CXR
Mediastinal shift away from the pneumothorax
How do you manage a tension pneumothorax?
Large bore IV cannula into the 2nd intercostal space mid clavicular line
Chest drain should be inserted into the affected side which is inserted into the safe triangle (mid axillary line 5th intercostal space)
How does a pulmonary embolus present?
Sudden onset breathlessness
Haemoptysis
Chest pain (pleuritic)
Low cardiac output followed by collapse if it is a massive PE
How would you manage a PE?
A full A to E assessment
Oxygen if hypoxic
Fluid resuscitation (if hypotensive)
Thrombolysis should be considered (eg. Alteplase) in a massive PE
Should be fully anti coagulated. Commence rivaroxaban/apixaban as first line treatment.
What is a massive pE?
This is a patient with a PE whom is haemodynamically unstable.
What are some complications of thrombolysis
Bleeding
Hypotension
Reperfusion arrhythmias
Systemic embolisation of a thrombus
Allergic reaction
How would you diagnose a PE?
Gold standard is a CTPA or the chest/thorax.
Wells score <4: D-dimer first and if positive then send patient for CTPA
Wells score >4: Send patient straight for CTPA.
If these tests can not be done promptly then consider anticoagulation prior to this. Eg. SC dalteparin.
