Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Thick Stuff > Respiratory - Level 1 > Flashcards

Respiratory - Level 1 Flashcards

1
Q

Pathology of asthma?

A

o Usually reversible either spontaneously or treatment
o 1. Airway narrowing
 Smooth muscle contraction, thickening of airway wall by cellular infiltration and inflammation
 Secretions within the airway
o 2. Inflammation
 Mast cells, eosinophils, T cells, dendritic cells cause IgE production and release of histamine, prostaglandin D2, leukotriene C4
o 3. Remodelling
 Hypertrophy and hyperplasia leading to more mucous secreting goblet cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Epidemiology of asthma?

A
  • 10-15% of people develop asthma in 2nd decade of life
  • More common in developed world
  • 15% of asthma induced at work
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Risk factors of asthma?

A
  • FHx of atopic disease
  • Respiratory infections in infancy
  • Tobacco smoke
  • Low birth weight
  • Social deprivation
  • Inhaled particulates
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Precipitating factors of asthma?

A
  • House dust mite and its faeces
  • Viral infections
  • Cold air
  • Exercise
  • Irritant dust, vapours, fumes (cigarettes, perfume, exhaust)
  • Emotion
  • Drugs (Aspirin, beta-blockers)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Symptoms of asthma exacerbation?

A

o Acute SOB and wheeze

o May have chest tightness and cough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Assessment of asthma exacerbation?

A

o PEFR
o Symptoms and response to treatment
o HR and RR
o O2 sats

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Severity assessment of asthma exacerbation - moderate?

A

 PEFR 50-75% best or predicted
 Increasing symptoms
 No features of acute severe asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Severity assessment of asthma exacerbation - severe?

A 
	Any 1 of: 
•	PEFR 33-50% best or predicted
•	Unable to complete sentences in 1 breath
•	RR ≥25
•	HR ≥110
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Severity assessment of asthma exacerbation - life-threatening?

A 
	Patient with severe asthma with any 1 of:
•	Altered consciousness
•	Cyanosis
•	Hypotension
•	Exhaustion, poor respiratory effort
•	Silent Chest
•	Threatening - SpO2<92% (PaO2<8kPa), PEFR <33%
•	Bradycardia
•	Normal pCO2 (4.6-6)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Severity assessment of asthma exacerbation - near-fatal asthma?

A

 Raised PaCO2 and/or requiring mechanical ventilation with raised inflation pressures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

DDX of acute asthma exacerbation?

A

Exacerbation of COPD

Infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Management of asthma exacerbations - initial assessment?

A

o Clinical features
o PEFR
o HR, RR, Pulse Oximetry
o Assess Severity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Management of asthma exacerbations - further investigations?

A

ABG (if O2 <92% or life-threatening)

CXR (if suspected pneumothorax, consolidation, life-threatening asthma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Management of asthma exacerbations - moderate asthma attack?

A

o Treat at home or in surgery and assess response to treatment
o Salbutamol via spacer every 60 seconds up to 10 puffs
o If no improvement – via salbutamol 5mg nebuliser
o Prednisolone 40-50mg for 5 days
o Admit if features of severe, life-threatening asthma or recent nocturnal symptoms/hospital admission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Management of asthma exacerbations -acute severe or life-threatening - initial management?

A

 Make sure patient is sitting up
 15L/min Oxygen via NRB mask if hypoxic (aim 94-98%)
 IV access (FBC, U&E, glucose, CRP, cultures (if septic))
 ABG
 Salbutamol 5mg (or terbutaline 10mg) nebulised with oxygen
• If does not respond – every 15 mins or continuous nebuliser
 Ipratropium Bromide 500mcg (0.5mg) added to nebulisers if poor initial response
• 4-6 hourly
 Hydrocortisone IV 100mg every 6 hours (or prednisolone PO 40-50mg for 5 days if can take orally)
 Magnesium Sulphate 1.2g-2g IV over 20 mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Management of asthma exacerbations -acute severe or life-threatening - further treatment?

A

o Senior review if not improving – consider ITU
 IV aminophylline IVI 5mg/kg over 20 mins
 IV salbutamol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Management of asthma exacerbations -acute severe or life-threatening - when to refer to ITU?

A

 Drowsiness, confusion, exhaustion, coma, worsening hypoxia, normo/hypercapnoea, ABG showing decreased pH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Management of asthma exacerbations -acute severe or life-threatening - if symptoms improving?

A

 Nebulised salbutamol every 4 hours
 Prednisolone 40-50mg OD PO for 5-7 days
 Aim for O2 at 94-98%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Monitoring of asthma exacerbations?

A

 HR, RR, O2 sats, ECG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Discharge advice given after acute severe asthma attack?

A

 PEFR >75% best or predicted 1 hour after treatment
 Oral Prednisolone OD 40-50mg for 5 days
 Review inhaler technique and PEFR by asthma liason nurse
 Advise GP follow-up within 2 days
 Respiratory clinic appointment within 4 weeks
 Return to hospital if symptoms worsen/recur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Classes of COPD patient?

A

Type 1 Respiratory Failure (Pink puffers)
 Low paO2, normal PaCO2
 Emphysema predominantly, breathless not cyanosed

Type 2 Respiratory Failure (blue bloaters)
 Low PaO2, High PaCO2
 Chronic bronchitis – cyanosed develop cor pulmonale and rely on hypoxic drive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Symptoms of COPD?

A 
o	Exertional dyspnoea
o	Cough
o	Sputum
o	Wheeze
o	Ask about present treatment, past medical history, exercise tolerance, recent history
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Signs of COPD?

A

o Dyspnoea, tachypnoea, accessory use muscles, lip pursing
o Hyperinflation (barrel chest)
o Wheeze/Coarse crackles
o Cyanosis, right heart failure (severe disease)
o Tremor, bounding pulse, peripheral vasodilatation, drowsiness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

DDx of exacerbation of COPD?

A
  • Asthma
  • Pulmonary Oedema
  • Pneumothorax
  • PE
  • URTI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Investigations to perform in COPD exacerbation?

A
  • SpO2, RR, HR, BP, Temp, PEFR
  • CXR
    o Look for hyperinflation, pneumothorax, bullae, pneumonia
  • ECG
  • ABG (documenting FiO2 and pCO2 to guide O2 therapy)
  • Bloods – FBC, U&E, glucose, theophylline levels, blood cultures, CRP
  • Sputum culture and microscopy
  • Blood cultures if pyrexia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Management of exacerbation of COPD - initial management?

A

o Sit patient upright
o Oxygen
 If hypoxic and before ABG result – give 15L/min via NRM
 Aim for SpO2 88-92%, give O2 28% via Venturi mask and obtain ABG
 Titrate up to minimum FiO2 to achieve 88-92%
o Investigations in breathing
 ABG
 CXR
o Salbutamol 5mg (or terbutaline 5-10mg) nebulised
o Ipratropium 0.5mg nebulised
 If hypercapnoeic, acidotic COPD – use compressed air for nebulisers
o Hydrocortisone IV 200mg or Prednisolone PO 30mg (for 7-14 days)
o Investigations in circulation
 IV access (FBC, U&E, glucose, blood cultures)
 ECG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Management of exacerbation of COPD - antibiotic therapy?

A

 Amoxicillin 500mg TDS PO for 5 days (Alt: Doxycycline)

 If no improvement over 2-3 days:
• Use alternative

 If unable to take oral antibiotics or severely unwell
• Amoxicillin 500mg TDS IV
• Co-amoxiclav 1.2g TDS IV
• Clarithromycin 500mg BDS IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Management of exacerbation of COPD - further treatments?

A

o IV aminophylline or IV salbutamol if no response to nebulised bronchodilator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Management of exacerbation of COPD - if no response to initial management?

A

o Consider NIV - if RR >30 or pH<7.35 or paCO2 rising
 CPAP or BiPAP

o If pH<7.26 and PaCO2 is rising despite NIPPV:
 Consider intubation and ventilatory support

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Management of exacerbation of COPD - discharge advice?

A

o Liaise with GP regarding steroid reduction
o Smoking cessation
o Flu and Pneumococcal Vaccine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Definition of acute bronchitis?

A

o Lower respiratory tract infection causing bronchial inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Epidemiology of acute bronchitis?

A
  • Prevalence = 4%

- Most during autumn or winter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Risk factors of acute bronchitis?

A

o Smoking

o Damp or dusty environment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Causes of acute bronchitis?

A 
o	Viral – rhinovirus, enterovirus, influenzas A and B, parainfluenza, coronavirus, RSV, adenovirus
o	Bacteria (1-10%) – Streptococcus pneumoniae, Haemophilus influenza, Moraxella catarrhalis
o	Rarely, atypicals – Mycoplasma pneumoniae, Chlamydophilia pneumoniae, Bordatella pertussis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Symptoms of acute bronchitis?

A 
o	Cough (clear/white)
o	+/- sputum, wheeze, breathlessness
o	Substernal or chest wall pain upon coughing
o	Sore throat
o	Fever
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Signs of acute bronchitis?

A

o Absence of focal chest signs or systemic upset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Clinical diagnosis of acute bronchitis?

A 
-	Clinical Diagnosis (O2 sats)
o	CRP – if uncertain about antibiotic indications
	<20 – no antibiotics
	20-100 – delayed antibiotics
	>100 – immediate antibiotics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Investigations in acute bronchitis?

A
  • If wanting to rule out pneumonia:

o CXR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Management of acute bronchitis - general advice?

A

 Adequate fluid intake
 PRN paracetamol/ibuprofen
 Other ideas – honey, OTC medications (honey, pelargonium)
 Stop smoking
 Seek medical help if symptoms worsen or do not improve after 3-4 weeks or become systemically unwell

40
Q

Management of acute bronchitis - when to give immediate antibiotics?

A

• CVD, CKD, cirrhosis, immunosuppressed, CF
• >65 with 2 or more, >80 with one or more:
o Hospital admission in last year, DM, Hx of CHF, use of corticosteroids
• CRP >100 immediately (delayed 20-100 – if symptom worse rapidly or significantly)

41
Q

Management of acute bronchitis - what immediate antibiotics to give - adults?

A

o Oral doxycycline 200mg 1st day then 100mg OD for 4 days (5-day total)
o Alternatives: Amoxicillin (pregnant women), clarithromycin, erythromycin

42
Q

Management of acute bronchitis - what immediate antibiotics to give - children <17?

A

o Oral amoxicillin for 5 days

o Alternatives: clarithromycin, erythromycin, doxycycline

43
Q

Management of acute bronchitis - follow up?

A

 Not necessary

 Seek medical help if symptoms worsen, do not improve after 3-4 weeks or very unwell

44
Q

Prognosis of acute bronchitis?

A

o Usually self-limiting and cough lasts 3-4 weeks
 ¼ will have cough for >4 weeks and may persist for up to 6 months (post-bronchitis syndrome)
o Antibiotics do not make a difference to duration of symptoms and have side effects

45
Q

Definition of tension pneumothorax?

A
  • Life-threatening emergency and requires prompt treatment
  • Gas progressively enters pleural space but unable to leave
  • Increased pressure causes complete lung collapse on affected side and mediastinal shift
  • Leads to kinking of great vessels therefore decreased venous return and cardiac output
  • Cardiac arrest can occur within minutes
46
Q

Causes of tension pneumothorax?

A

o Trauma
o Iatrogenically (insertion of central line, CPR)
o IPPV
o Lung disease (Asthma or COPD)

47
Q

Symptoms of tension pneumothorax?

A

o SOB, dyspnoea, acute respiratory distress

o Chest pain

48
Q

Signs of tension pneumothorax?

A

o Absent breath sounds on affected side
o Hyper-resonant over affected lung
o Tracheal deviation away from affected side
o Distended neck veins, tachycardia, hypotension, loss of consciousness

49
Q

Management of tension pneumothorax - initial management?

A 
o	15L/min O2 by NRB mask
o	Insert IV cannula (16G or larger) into 2nd intercostal space MC line just above third rib
o	Axillary chest-drain immediately
o	Remove cannula
o	Check patient okay and CXR
50
Q

Management of tension pneumothorax - how to insert Chest drain?

A

 Give IV opioid analgesia
 Abduct arm fully
 Clean skin and sterilise
 Identify 5th ICS just anterior to MA line
 Local anaesthetic (1% lidocaine + adrenaline) under skin and down to periosteum
 28-32FG chest drain
 Make 2-3cm incision in line of ribs
 Use blunt dissection with artery forceps and insert gloved finger into pleural cavity to ensure no adhesions
 Insert chest drain ensuring all drainage holes are in chest cavity
 Connect drain to underwater seal and look for swinging
 Suture drain securely in place and cover with adhesive dressing
Obtain CXR

51
Q

Risk factors for PE?

A 
o	Surgery (pelvic/abdominal)
o	Thrombophilia
o	Leg fracture
o	Bed rest/Reduced mobility
o	Malignancy
o	Pregnancy
o	OCP/HRT
52
Q

Causes of PE?

A 
o	Embolism of DVT
o	RV thrombosis (post-MI)
o	Right endocarditis
o	Fat, air or amniotic fluid
o	Neoplastic cells
53
Q

Symptoms of PE?

A 
o	Acute dyspnoea
o	Pleuritic chest pain
o	Cough and Haemoptysis
o	Syncope
o	Symptoms of DVT
54
Q

Signs of PE?

A 
o	Tachycardia
o	Tachypnoea
o	Hypotension
o	Pyrexia with lung infarction
o	Pleural rub
o	Cyanosis
o	Gallop rhythm
o	Increased JVP
o	RV heave
55
Q

Assessment of PE? What is PE rule out criteria?

A 
o	ECG
o	CXR
o	Pulmonary Embolism Rule-Out Criteria
	Rule out PE if none of 8 criteria are present with low Wells Score (<2)
•	age < 50 years
•	pulse < 100 beats min
•	SaO2 ≥ 95%
•	No haemoptysis
•	No oestrogen use
•	No surgery/trauma requiring hospitalization within 4 weeks
•	No prior VTE
•	No unilateral leg swelling
56
Q

Initial investigations of PE?

A

o Full history and examination of respiratory and CV systems
o Examine legs for signs of DVT
o CXR
 Often normal – wedge shaped area of infarction, decreased vascular markings, small pleural effusion
 Excludes pneumonia and pneumothorax
o PE Wells Score

57
Q

What is the PE wells score?

A

Embolism History (DVT/PE) 1.5

Malignancy (on treatment, treated in the last 6 months, or palliative) 1

Bed for more than 3 days or surgery in the previous 4 weeks 1.5

Oral haemoptysis 1

Leg DVT signs and symptoms (minimum of leg swelling and pain with palpation of the deep veins) 3

Increased HR >100bpm 1.5

Most likely diagnosis is PE 3

58
Q

Management of Well’s PE score of more than 4?

A

Immediate CTPA
o If CTPA cannot be carried out immediately – interim LMWH anticoagulation and hospital admission
o IF CTPA negative and DVT suspected – proximal leg US
o V/Q Scan - If allergy to contrast or renal impairment (eGFR<30) or pregnant or woman <40

Diagnosed PE with positive CTPA or V/Q scan

Consider alternative diagnosis if negative CTPA and no suspected DVT

59
Q

Management of PE if Well’s score 4 or less?

A

• D-Dimer
o If positive, then CTPA
 If CTPA cannot be carried out immediately – interim LMWH anticoagulation and hospital admission
 V/Q Scan
• If allergy to contrast or renal impairment (eGFR<30) or pregnant or woman <40
o If negative D-dimer or positive D-dimer and negative CTPA, then excluded

60
Q

Other tests to be performed in A-E of PE management?

A

 Bloods
• FBC, U&Es, baseline clotting, D-Dimer (if Wells of <4 to exclude PE)

 ABG (if hypoxic, SOB)
• Low PaO2, Low PaCO2, pH often raised

 ECG (if tachycardic or chest pain)
• Commonly normal – can have sinus tachycardia, RBBB, RV strain pattern (S1Q3T3), RAD, AF
• S1Q3T3 – in up to 50% (sign of Cor Pumonale)

61
Q

Diagnostic imaging in PE?

A

o CTPA
 First-line
 When Wells >4 or, elevated D-Dimer
o V/Q Scanning
 Used in pregnancy or young people (women<40)
 Usually need CTPA afterwards to confirm

62
Q

Initial management of PE?

A 
o	If hypoxic – 15L/min Oxygen
o	Analgesia (Morphine) + Antiemetic – if in pain or very distressed
63
Q

Management of massive PE?

A

o If massive PE/haemodynamically unstable (BP <90mmHg, hypoxic, tachycardia, tachypnoea):
 Urgent ICU help
 Rapid colloid infusion
 If BP still <90mmHg – consider dobutamine then IV noradrenaline infusion
 Alteplase 100mg over 2 hour or 0.6mg/kg over 15 mins

64
Q

Management of diagnosed PE - pharmacological interventions? What if cannot have anticoagulation therapy? What if recurrent DVT?

A

LMWH (175U/kg Tinzaparin SC/24h) as soon as possible for at least 5 days or until INR >2 for at least 24 hours, whichever is longer
• For severe renal impairment (eGFR <30) – Unfractionated heparin (UFH)
• If PE and haemodynamically unstable – offer UFH and thrombolytic therapy

Warfarin offered within 24 hours of diagnosis and continue for 3 months provoked / 6 months unprovoked PE
• Alternatives: NOACs (Apixaban, dabigatran, rivaroxaban)

If cannot have anticoagulation therapy:
• Temporary inferior vena cava filter

If recurrent DVT:
• Inferior vena cava filter after alternatives (raise INR 3-4, switching to LMWH)

65
Q

Management of diagnosed PE - thrombolytic therapy?

A
  • Consider systemic thrombolytic therapy for patient with haemodynamic instability
  • Alteplase 100mg over 2 hour or 0.6mg/kg over 15 mins
66
Q

Management of diagnosed PE - Investigations to find cause?

A

 Cancer investigations for unprovoked DVT:
• Examination
• CXR
• Bloods (FBC, serum Ca, LFTs)
• Urinalysis
• Consider abdomino-pelvic CT scan if >40 with 1st unprovoked DVT

 Thrombophilia testing
• Antiphospholipid antibodies in patients with unprovoked DVT if it is planned to stop anticoagulation therapy
• Hereditary thrombophilia testing – unprovoked DVT with 1st degree relative with DVT/PE if planned to stop anticoagulation

67
Q

When to test for thrombophilias after diagnosed PE?

A
  • Antiphospholipid antibodies in patients with unprovoked DVT if it is planned to stop anticoagulation therapy
  • Hereditary thrombophilia testing – unprovoked DVT with 1st degree relative with DVT/PE if planned to stop anticoagulation
68
Q

What tests are performed to investigate cancer after diagnosed PE?

A
  • Examination
  • CXR
  • Bloods (FBC, serum Ca, LFTs)
  • Urinalysis
  • Consider abdomino-pelvic CT scan if >40 with 1st unprovoked DVT
69
Q

Definition of pneumonia?

A
  • Pneumonia is an acute infection of the lung parenchyma
70
Q

Classes of pneumonia?

A

o Lobar – one or more lobes

o Broncho- Affecting lobules and bronchi

71
Q

Epidemiology of pneumonia?

A
  • Major cause of death in over 70s
  • Incidence 1%
  • Mortality 20% in hospital
72
Q

Aetiology of pneumonia?

A 
o	Cigarette smoking
o	Hospitalised
o	Alcohol
o	Bronchiectasis
o	Lung cancer
o	Immunosuppression/IVDU
73
Q

Causative organisms of community acquired pneumonia?

A 
Bacterial (80-90%)
•	Streptococcus pneumoniae
•	Haemophilus influenza
•	Mycoplasma pneumoniae
•	Legionella (Air conditioning)
•	Chlamydia psittaci (birds)
•	TB

Viral (10%)
• Influenza A&B, RSV

74
Q

Causative organisms of hospital acquired pneumonia?

A

HAP (>48h after admission)

 Gram-neg enterobacteria
 S.Aureus
 Pseudomonas
 Kleibsiella

75
Q

Causative organisms of aspiration pneumonia?

A

 Oropharyngeal Anaerobes

76
Q

Symptoms of pneumonia?

A 
o	Fever
o	Cough
o	Sputum – green
o	SOB
o	Pleuritic chest pain
o	Myalgia
o	Rigors
o	Haemotypsis
77
Q

Signs of pneumonia?

A 
o	Fever
o	Cyanosis
o	Confusion
o	Tachycardia
o	Tachypnoea
o	Hypotension
o	Consolidation (diminished expansion, dull percussion, increased tactile vocal fremitus, bronchial breathing), pleural rub
78
Q

Severity assessment of person with pneumonia in primary care?

A

o In primary care – CRB-65 score
 0 – low risk – home management
 1-2 intermediate risk – hospital admission
 3-4 – high risk – urgent admission

79
Q

Severity assessment of person with pneumonia in hospital?

A 
o	CURB-65 Score
	Confusion (AMTS≤8)
	Urea >7mmol/L
	RR ≥30/min
	BP <90/60mmHg
	Age≥65
•	Score of 0 or 1 - managed at home
•	Score of 2 –inpatient treatment, oral Abx
•	Score of ≥3 – admit to ICU, IV Abx
80
Q

Investigations to perform in hospital in pneumonia?

A

o RR, HR, BP, glucose, SpO2 (ABG <94% or known COPD)
 If SEPSIS, start BUFALO and ABCDE SEPSIS management

o CXR - Patchy or lobar consolidation, mass lesions or air bronchogram

o Bloods
 FBC, U&Es, LFT, CRP, atypical serology

o Blood Cultures

o Sputum cultures

o Consider pneumococcal and legionella urinary antigen tests

81
Q

When to refer pneumonia to hospital?

A

o Cardiorespiratory failure
o Sepsis
o Symptoms not improving with antibiotics
o Unable to take oral medications

82
Q

Management of pneumonia - general advice?

A

o Stop smoking
o Paracetamol for pleuritic pain
o Adequate fluid intake

83
Q

Management of pneumonia - initial hospital management?

A

o Oxygen (if hypoxic)
o Simple Analgesia
o IV fluids if hypotensive
o Antibiotics (started within 4 hours of diagnosis (1 hour if sepsis))

84
Q

Management of community acquired pneumonia - antibiotic therapy - CURB65 0/1?

A
  • Oral Amoxicillin 500mg TDS for 5 days

* Alternatives – Doxycycline, clarithromycin, erythromycin (pregnancy)

85
Q

Management of community acquired pneumonia - antibiotic therapy - CURB65 2?

A
  • Oral Amoxicillin 500mg TDS + Clarithromycin 500mg BD – if atypical suspected for 5 days
  • Alternatives – Doxycycline, Erythromycin (in pregnancy)
86
Q

Management of community acquired pneumonia - antibiotic therapy - CURB65 3/4/5?

A
  • IV Co-amoxiclav 1.2g TDS + Clarithromycin 500mg BD for 5 days
  • Alternatives – Oral co-amoxiclav, erythromycin (pregnant), levofloxacin
87
Q

Management of pneumonia - if no improvement?

A

 Contact ICU and prepare for central line and urinary catheter insertion
 Aim for CVP>8mmHg, MAP>65mmHg, Urine output >0.5mg/kg/hr

88
Q

Management of hospital acquired pneumonia - antibiotic therapy - non-severe?

A
  • Oral Co-amoxiclav 500/125mg TDS for 5 days then review

* Alternatives: Doxycycline, cefalexin, co-trimoxazole

89
Q

Management of hospital acquired pneumonia - antibiotic therapy - severe?

A
  • IV tazocin 4.5g TDS, 48h and then review

* Alternatives: Ceftazidime, ceftriaxone, cefuroxime, meropenem

90
Q

When should you not discharge patient with pneumonia?

A

o Do not discharge if 2 or more of following:

 Temperature >37.5, RR >24, HR>100, BP <90, O2 <90%ora, abnormal mental status, unable to eat or drink

91
Q

Follow up advice for patient after pneumonia?

A

o CXR at 6 weeks if symptoms persisting despite treatment or high risk of underlying malignancy (smokers or people over 50)

92
Q

Complications of pneumonia?

A 
o	Pleural effusion
o	Empyema
o	Lung Abscess
o	Respiratory failure
o	Sepsis
o	Pericarditis
o	AKI
93
Q

Oxygen management - 1 - critically ill requiring O2?

A

15L/min via Non-rebreathe (Reservoir) mask

Once stable - reduce oxygen dose and aim 94-98%

COPD - same initial target sats - measure ABG and move to controlled oxygen if needed

94
Q

Oxygen management - 2 - serious illness requiring moderate if patient hypoxic?

A

Initial O2 - 2-6L/min nasal cannula or 5-10L/min via facemask

If O2 <85% - 15L/min via non-rebreathe mask

Aim 94-98%

95
Q

Oxygen management - 3 - COPD and other conditions requiring controlled oxygenation?

A

Use 28% Venturi aiming 88-92% until ABG available

If CO2 raised or Hx of IPPV/NIV then continue 88-92%, if not then aim 94-98%

If high O2 sats - reduce dose of O2

Recheck ABG within 60 minutes or earlier if deterioration - if pH<7.35, H >45, PCO2 >6.0 - senior for NIV or ventilation

96
Q

Indications for NIV?

A

Respiratory acidosis - pH<7.35 or PCO2>6.0

In people with COPD, respiratory muscle weakness, chest wall deformity, obesity hypoventilation

97
Q

Difference between CPAP and NIV/BiPAP?

A

CPAP - does not reduce CO2 - don’t use in T2RF

NIV/BiPAP - difference between IPAP and EPAP increases patients tidal volume and decreased arterial CO2

Thick Stuff (87 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions