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Clinical skills Yr2 > Respiratory Emergencies: Life-threatening Asthma, tension pneumothorax, PE, Respiratory failure, Pulmonary Edema > Flashcards

Respiratory Emergencies: Life-threatening Asthma, tension pneumothorax, PE, Respiratory failure, Pulmonary Edema Flashcards

1
Q

What are the classic signs and symptoms of life-threatening asthma?

A

33 92 A CHEST mnemonic: If a patient has one of the following it is life-threatening asthma

PEFR is less than 33% of personal best

Oxygen saturation is less than 92%

C: Cyanosis and confusion
H: Hypotension: Dizziness, weakness, blurred vision, fainting
E: Exhaustion
S: Silent chest
T: Threatening PEF

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2
Q

How do you manage life-threatening asthma?

A

OSHITME mnemonic

O: High-flow oxygen

S: Nebulised salbutamol, ideally oxygen-driven

H: Hydrocortisone

I: Ipratropium bromide

T: Theophylline

M: Magnesium sulfate

E: Escalate care

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3
Q

In life-threatening asthma management, how is high-flow oxygen administered and what should the result be?

A

High-flow oxygen through tight fitting mask or nasal cannula

Keep oxygen saturation between 94-98%

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4
Q

In life-threatening asthma management, what dose of nebulised salbutamol is given, and in what kind of nebuliser?

A

5mg for adults, 2.5mg for children

Ideally air-driven nebuliser to prevent risk of overoxygenation, otherwise use oxygen-driven nebuliser

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5
Q

In life-threatening asthma, what dose and route is used to administer hydrocortisone?

A

100mg IV hydrocortisone

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6
Q

In life-threatening asthma, what is the second-line steroid that should be used if hydrocortisone can’t be used?

A

Prednisolone 40-50mg PO

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7
Q

In life-threatening asthma, what is the mechanism of ipratropium bromide, and give 2 reasons why it is used?

A

Anticholinergic drug used to control symptoms of bronchospasm

Added to nebulised salbutamol to increase initial response and has minimal side effects

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8
Q

In life-threatening asthma management, what dose and route is used to administer ipratropium bromide?

A

500 micrograms NEB for adults, 250 micrograms NEB children aged 2-12

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9
Q

In life-threatening asthma management, what dose and route is used to give theophylline?

A

1g aminophylline infusion IV

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10
Q

In life-threatening asthma management, what dose and route is used to give magnesium sulfate, and for how long?

A

Stat dose 2g magnesium sulfate IV

Given over 20 minutes

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11
Q

What is the role of magnesium sulfate in treating life-threatening asthma?

A

Produces rapid and marked bronchodilation

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12
Q

What is flail chest?

A

Life-threatening condition where segment of rib cage breaks due to trauma and detaches from chest wall

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13
Q

What are the 4 classic signs of flail chest?

A

Paradoxical movement of chest wall where broken segment draws in when patient inhales and chest expands, and segment moves out when patient exhales and chest shrinks

Dyspnea

Chest pain

Bruising in affected area

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14
Q

What are the 5 early symptoms of tension pneumothorax?

A

SOB

Pleuritic pain radiating to ipsilateral back and shoulder

Tachypnea

Tachycardia

Hypotension

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15
Q

What are the 5 early signs of tension pneumothorax?

A

Cyanosis

Jugular venous distension

Chest retractions

Tracheal deviation

Hypotension

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16
Q

What is the emergency management of tension pneumothorax in 2 steps?

A
  1. Needle decompression in 2nd intercostal space on mid-clavicular line
  2. Administer high flow oxygen
17
Q

What are the causes of cardiac and non-cardiac pulmonary edema? (NOT CARDIAC)

A

Cardiac: Heart failure

N: Near drowning

O: Oxygen therapy

T: Transfusions reaction TRALI

C: CNS (neurogenic)

A: Allergic reaction

R: Renal failure

D: Drugs

I: Inhaled toxins

A: Altitude eg. ARDS

C: Contusion

18
Q

Give 6 signs of pulmonary edema?

A

SOB during movement or lying down

Haemoptysis or pink frothy mucus

Wheezing or gasping

Cold and clammy skin

Anxiety

Palpitations

19
Q

If you suspect someone has a pulmonary edema, what radiological investigation should you do and what are the 3 classic signs?

A

CXR in PA view

Cardiomegaly

Kerley-B lines

Batwing opacities

20
Q

If you suspect a patient has pulmonary edema, what are the 3 classic signs in a respiratory exam?

A

JVP

Ankle/peripheral edema

Crackles on auscultation

21
Q

What is the acute management of pulmonary edema? (POND)

A

P: Position

O: Oxygen

N: Nitroglycerin

D: Diuretics

22
Q

Which 6 lab investigations should you do to confirm pulmonary edema?

A

BNP blood test: Elevated

ABG: Low PaO2 and low PaCO2, if PaCO2 is normal or raised this indicates patient is exhausted and not ventilating properly

Troponin: Acute MI could cause heart failure

U&Es

LFTs: hypoalbuminaemia

FBC

23
Q

How should you position a patient with pulmonary edema, in acute management?

A

Patient should be sitting up straight

Corrects V/Q mismatch and allows gravity-dependent drainage of capillary leaks

24
Q

How do you administer oxygen therapy to patients with pulmonary edema, in acute management?

A

Non-rebreathe mask with 15L oxygen flow rate

25
Q

In which 3 cases is nitroglycerin used to treat pulmonary edema?

A

Concomitant MI

Severe hypertension

Mitral regurgitation

26
Q

Which diuretic is used for acute management of pulmonary edema?

A

Furosemide

27
Q

What is type 1 respiratory failure and type 2 respiratory failure?

A

Type 1 respiratory failure: Failure of gas exchange which causes hypoxaemia (PaO2 less than 8) and normocapnia (PaCO2 less than 6)

Type 2 respiratory failure: Failure of gas exchange and ventilation which causes hypoxaemia and hypercapnia (PaCO2 more than 6)

28
Q

What is the main pathophysiology of type 1 respiratory failure?

A

Ventilation/perfusion mismatch

29
Q

What is the main pathophysiology of type 2 respiratory failure?

A

Alveolar hypoventilation

30
Q

Give 4 causes of type 1 respiratory failure?

A

Pnemonia

Pulmonary edema

Bronchoconstriction

PE

31
Q

Give 4 causes of type 2 respiratory failure?

A

COPD exacerbation

Opiate/sedative overdose

Rib fractures

Guillain-Barré syndrome

32
Q

Which investigations should you do for respiratory failure?

A

FBC

Sputum culture

ABG

CXR

Obs

33
Q

What are the 5 signs of severe asthma attack?

A

Peak flow of 33%-50% of their best or predicted PEFR

Oxygen saturations of less than 92%

Unable to complete sentences in one breath

Respiration rate over 25 breaths per minute

Heart rate more than 110 beats per minute.

34
Q

What are the 5 signs of a moderate asthma attack?

A

Peak flow of less than 50%-75% of their best or predicted PEFR

Oxygen saturations of more than 92%

Speaking in full sentences

Respiration rate below 25 breaths per minute

Heart rate below 110 beats per minute.

Clinical skills Yr2 (18 decks)

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