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Junior Medicine > Respiratory Emergencies > Flashcards

Respiratory Emergencies Flashcards

1
Q

What is anaphylaxis and angioedema?

A

A serious allergic reaction in a sensitisted individual when exposed to a specific antigen

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2
Q

What are some of the clinical signs and symptoms of anaphylaxis and angioedema?

A
  • Pruritis
  • Urticaria
  • Angioedema
  • Hoarse voice
  • Progressing stridor and bronchial obstruction
  • Wheeze
  • Chest tightness from bronchospasm
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3
Q

How do you manage anaphylaxis?

A
  • Remove trigger
  • Maintain airway, give 100% O2
  • Intramuscular adrenaline (0.5mg 1 in 1000)
  • IV hydrocortisone 200mg
  • IV chlorphenamine 10mg

Treat bronchospasm: NEB salbutamol

Treat laygenal oedema: NED adrenaline

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4
Q

How do you quantify a mild asthma attack?

A
  • No features of severe asthma
  • PEFR >75%
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5
Q

How do you quantify a moderate asthma attack?

A
  • No features of severe asthma
  • PEFR 50-75%
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6
Q

How do you quantify a severe asthma attack?

A

Any one of the following:

  • PEFR 33-50%
  • Cannot talk in complete sentences
  • RR >25/min
  • HR >110/min
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7
Q

How do you quantify a life threatening asthma attack?

A

Any one of the following

  • PEFR <33%
  • O2 sats <92%
  • ABG pO2 <8kPa
  • Cyanosis
  • Poor respiratory effort
  • Silent chest
  • Exhaustion, confusion, hypotension, arrythmia
  • pCO2 is normal
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8
Q

How do you quantify a near fatal asthma attack?

A

Features of life threatening asthma + RAISED pCO2

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9
Q

How do you manage an acute asthma attack?

A
  • ABCDE
  • Aim for sats 94-95% with oxygen
    • do ABG if sats <92%
  • 5mg nebulised salbutamol - can give back to back every 15 minutes
  • 40mg prednisolone PO , or IV hydrocortisone if PO no possible
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10
Q

How do you manage a severe asthma attack?

A
  • ABCDE
  • Aim for sats 94-95% with oxygen
    • do ABG if sats <92%
  • 5mg nebulised salbutamol - can give back to back every 15 minutes
  • 40mg prednisolone PO , or IV hydrocortisone if PO no possible
  • Nebulised Ipratropium bromide 500micrograms
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11
Q

How do you manage a life threatening or near fatal asthma attack?

A
  • Same as a severe asthma attack PLUS
  • Urgen ITU / anaeasthetist assessment
  • Consider portable CXR
  • IV Aminophylline
  • Consider IV salbutamol id nebulused route ineffective
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12
Q

How do you manage an exacerbation of COPD?

A
  • ABCDE
  • O2 via fixed performance face mask
    • only aim for 88-92% sats is retaining CO2 (guided by ABG)
  • Nebulised salbutamol and ipratropium
  • Prednisolone 30mg STAT then OD for 7 days
  • Abx if CRP/WCC is raised or purulent sputum
  • CXR
  • Consider IV aminophylline
  • Consider NIV if type 2 respiratory failure
  • Consider ITU if pH <7.2
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13
Q

What is pneumonia?

A

Consolidation on CXR with fever +/- purulent sputum +/- raised WCC and/ or CRP

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14
Q

How do you manage a patient with pneumonia?

A
  • ABCDE
  • Any features of sespsis start sepsis 6
  • Otherwise treat with antibiotics as per CURB - 65
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15
Q

What is assessed in CURB-65?

A
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16
Q

How do you manage massive haemoptysis?

A
  • ABCDE
  • Lie patient on side of suspected lesion (if known)
  • Oral tranexamic acid 5 days (or IV)
  • STOP any NSAIDs, aspirin, anticoagulants
  • Abx if any evience of respiratory tract infection
  • Consider Vitamin K
  • CT aortagram
17
Q

What are the features of a tension Pneumothorax?

A
  • Hypotension
  • Tachycardia
  • Deviated trachea away from affected side
  • Mediastinal shift away from pneumothorax
18
Q

How do you manage a tension pneumothorax?

A
  • Large bore IV vannula into the 2nd ICS midclavicular line
  • Chest drain into affected side
19
Q

What are some of the symptoms of a PE?

A
  • Chest pain
  • SOB
  • Haemoptysis
  • Low cardiac output followed by collapse
20
Q

What are some of the major risk factors for a PE?

A
  • Surgery - especially abdo/pelvic, knee/hip replacement, any post op stay on ITU
  • Obstetric - late pregnancy, C section
  • Malignancy - abdo/ pelvis/ advanced/ metastatic
  • Lower limb - fracture , varicose veins
  • Reduce mobility
  • Previously proven VTE
21
Q

How do you manage a PE?

A
  • ABCDE
  • Oxygen if hypoxic
  • Fluid resicitation if hypotensive
  • Thrombolysis if massive PE confirmed on CTPA
    • consider without scan if high clinica suspicion and cardiac arrest imminent
    • check any contraindications first
  • Fully anticoagulate
22
Q

What is a massive PE? How is it managed?

A

PE with

  • hypotension/ imminent cardiac arrest
  • signs of right heart strain on CT/ ECHO
  • Consider thrombolysis with IV alteplase
23
Q

When is thrombolysis contraindicated?

A
  • Haemorrhagic stroke or ischaemic stroke < 6months ago
  • CNS neoplasia
  • Recent trauma/ surgery
  • GI bleed <1 month
  • Bleeding disorder
  • Aortic dissection
24
Q

What are some of the complications of thrombolysis?

A
  • Bleeding
  • Hypotension
  • Intracranial haemmorhage/ stroke
  • Reperfusion arrythmias
  • Systemic embolisation of thrombus
  • Allergic reaction
25
Q

What are the 2 causes of COPD exacerbation?

A

Infective

  • change in sputum volume/ colour
  • Fever
  • Raised WCC/ CRP

Non infective

Junior Medicine (6 decks)

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