Respiratory Ix and Mx Flashcards
Acute severe Asthma Investigations
- FBC
- U&Es
- CRP
- Blood cultures
- Sputum culture
- Peak expiratory flow – but may be too ill
- ABG if severe asthma (SpO2
Acute severe Asthma Management
• Asses severity of the attack (can they speak, RR, HR, sats
Immediate treatment:
• Salbutamol nebulized with O2
• Hydrocortisone IV or prednisolone orally (both if very ill)
• Start O2 if sats
Chronic asthma Investigations
- Peak expiratory flow monitoring
- Spirometry + test with Beta2 agonist or steroid
- CXR may show hyperinflation
- Skin-prick tests to identify allergens
- Histamine or methacholine challenge
- Aspergillus serology
Chronic asthma Management
- Educate on inhaler technique
- Stop smoking
Start at step most appropriate to severity, moving up or down as needed:
- Short-acting beta2 agonist e.g. salbutamol or ipartorpium brominde (anticholinergic)
- Add inhaled steroid e.g. beclometasone
- Add long-acting beta2 agonist e.g. salmeterol
- Consider wither: Increase beclometasone dose, modified-release theophylline
- Add regular oral prednisolone
COPD exarcerbation Investigations
- Bloods
- U&Es
- CRP
- Blood culture
- Sputum culture if green
- ECG
- ABG
- CXR
COPD exarcerbation Management
- ABCD approach
- Look for cause e.g. infection or Pneumothorax
- Nebulized bronchodilators → salbutamol (beta2 agonist) and ipatropium bromide (anticholinergic)
- Controlled oxygen therapy is sats
Pneumonia Investigations
- Bloods + atypical serology
- U&Es
- CRP
- LFTs
- Blood cultures
- Sputum culture
- Oxygen sats + ABG if SpO2
Pneumonia Management
- ABCD approach
- Treat hypoxia with oxygen if present
- Consider IV support
- Do a CURB-65 test for severity
- Broad IV Abx
- Analgesia for pleuritic chest pain e.g. paracetamol → if there was pleurisy
- Venous thromboembolism (VTE) prophylaxis
- Follow up CXR at 6 weeks
PE Investigations
- Bloods
- D-Dimer → only perform in patients without a high probability of a PE, as a negative D-dimer will effectively exclude a PE in those with a low or intermediate clinical probability, and imaging is not required. However a positive test does not confirm a PE, and imaging is required.
- Blood clotting
- PE Wells score
- CXR
- ECG
- ABG
- CT pulmonary angiography
- Ventilation-perfusion scan
PE Management
- ABCD approach
- Oxygen if hypoxic
- Morphine with anti-emetic if patient is in pain
- Compression stockings
- If critically ill consider immediate thrombolysis
- IV access and start anticoagulation → low molecular weight heparin e.g. tinzaparin
- Start warfarin
DVT Investigations
• FBC
• U&Es
• CRP
• DVT wells score
o or equal 2 → Do a D-dimer and USS.
• Dopler USS
• Thrombophillia test before commencing anticoagulant therapy
• Look for underlying malignanacy:
o Urine dip
o LFTs
o Ca2+
o CXR
o CT abdomen and pelvisDVT Management
- ABCD approach
- Analgesia
- LMWH or fondaparinux
- Cancer patients should receive LMWH for 6 months
- Start wafarin with the LMWH
- Stop heparin when INR is 2-3
- Compression stockings
- Thrombolytic therapy (to reduce damage to venous valves) may reduce complications but risks major bleeding.
Lung Cancer Investigations
- Cytology: sputum and pleural fluid
- CXR
- Percutaneous fine needle aspiration or biopsy of peripheral lesions and superficial lymph nodes
- CT to stage the tumour and guide bronchoscpy
- Bronchoscopy to give histology and asses operability
- PET CT scan to help staging
- Radionuclide bone scan if suspected mets
- Lung function tests – to help asses suitability for lobectomy
Lung Cancer Management
Non-small cell tumours:
• Excision for peripharal tumour with no mets
• Radiotherapy
• Chemotherapy and radiotherapy for more advanced disease
Small cell tumours:
• Chemotherapy – but nearly always relapse
• Pallitive care – radiotherapy, endobronchial therapy, pleural drainage, and drugs for the pain.
Pneumothorax Investigations
- CXR
* ABG
