Respiratory emergencies

Question 1

Explain the neural circuits in the medulla

Answer 1

Ventral and dorsal respiratory groups

leave spine at level C345

to form phrenic nerve
innervate diaphragm

Question 2

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Answer 2

t1-t12 also

Question 3

What differentiates the two types of respiratory failure?

Answer 3

Differentiated by carbon dioxide levels

Question 4

Assessing acutely unwell patient

Answer 4

Airway
Breathing
Circulation

Question 5

What is type 1 respiratory failure?

Answer 5

Type 1 - normal or low co2 partial pressure??

Question 6

What is type 2 respiratory failure?

Answer 6

high co2 as alveolar cannot get air out

Question 7

D

Answer 7

GCS
Glucose
Pupils
Neuro exam

Question 8

E

Answer 8

Abdomen

Signs of overload

Question 9

On a CXR how would you tell hyperinflammation?

Answer 9

More than six anterior ribs

Question 10

What is asthma?

Answer 10

Chronic inflammatory airway disease characterised by reversible airway obstruction

Question 11

What counts as a moderate asthma attack?

Answer 11

Peak flow between 50-75% of their best

Question 12

Severe asthma

Answer 12

PEF between 33-50%
Resp rate above 25
Heart rate above 110
Inability to compete sentences in one breath

Question 13

What are the key features of severe threatening asthma?

Answer 13

Cyanosis
Hypotension
Exhaustion, normal pCO2
Silent chest
Tachy/brady arrhythmias

Question 14

What counts as cyanosis?

Answer 14

SpO2 <92%

PaO2<8kPa

Question 15

Treatmet for life threatening asthma

Answer 15

Oxygen
Brochodilator
Steroids

Question 16

If they improve with treatement, what do you do?

Answer 16

TAME the asthma
Techniue 
AVoid triggers
Monitor PEF
Education

Question 17

What bronchodilators do you give?

Answer 17

Salbutamol
Ipratropium
IV magnesium

Question 18

If they don’t improve and you call ITU, what are the next steps?

Answer 18

High flow oxygen

Ventilation

Question 19

What does decompensation mean?

Answer 19

if ph is normal, it’s compensated

if ph is not compensated

Question 20

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Answer 20

Moderate

Question 21

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Answer 21

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Question 22

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Answer 22

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Question 23

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Answer 23

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Question 24

Wat is the management?

Answer 24

Oxygen
Bronchodilators
Steroids
Antibiotics

Question 25

What is NIV

Answer 25

non invasive ventilation

Question 26

what is BIPAP

Answer 26

Vi level continous positive airway pressure

inspiratory pressure forces air into lungs

expiratory pressure - presure in lungs at the end of expiration

Question 27

When do you have to ventilate with COPD?

Answer 27

Respiratory acidosis means you have to ventilate

Question 28

What is PE

Answer 28

Venous thrombi that pass into the pulmonary circulation, normally arisingf from DVTs

Question 29

RF for PE

Answer 29

Immobilisation
Malignacy
Recent surgery
HRT/COcP
Smoking

Question 30

Gold standard for PE diagnosis

Answer 30

CT Pulmonary angiogram

Question 31

What do you do if someone’s pregnant and can’t do a CTPA?

Answer 31

Ventilation/perfusion scan (V/Q scan)

Wells score/geneva score

Question 32

What would you see on an ECG if there was right heart strain due to PE?

Answer 32

Deep s waves in lead 1
Deep q waves in lead 2
T wave inversion in lead 3

Question 33

How do you manage PE?

Answer 33

See if they’re haemodynamically stable - ABCDE

Question 34

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Answer 34

If they’re ???

Question 35

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Answer 35

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Question 36

What is PO

Answer 36

accumulation of fluid within lung parenchyma, resulting in impaired gaseous exchange

Question 37

Causes of PO

Answer 37

Cardiogenic - heart failure, arrhythmias,

Question 38

Management of PO

Answer 38

Sit pt upright
Give oxygen if hypoxic
high dose IV diuretics
Treat cuase e.g. BB for arrythmia

Question 39

If pt improves

Answer 39

Regular diuretics
Fluid restriction
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Question 40

How do you treat tension pneumothorax with cardiopulmonary compromise?

Answer 40

Emergency needle decompression
High flow oxygen
chest drain

Question 41

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Answer 41

ha1510@ic.a.cuk