Respiratory terminology Flashcards
what is interstitial lung disease
umbrella term describing lung conditions that affect the lung parenchyma (tissue) causing inflammation and fibrosis
what is fibrosis
replacement of normal elastic lung tissue to scarred tissue that is stiff and does not function effectively
Conditions under umbrella of ILD
asbestosis
cyrptogenic organising pnuemonia
hypersensitivity pnuemonitis
idiopathic pulmonary fibrosis
drug induced pulmonary fibrosis
secondary pulmonary fibrosis
what is hypersensitivity pneumonitis
type III hypersensitivity reaction to an environmental allergen that causes parenchymal inflammation and destruction in people that are sensitive to that allergen
what is acute bronchitis
usually an inflammatory response to a virus
rarely a bacterial cause or inflammatory response to an irritant
What is asthma
chronic inflammatory condition of the airways that causes episodic exacerbations of bronchoconstriction
Risk factors PE
Immobility (long haul flight, recent surgery)
Pregnancy
Hormone therapy with oestrogen
Malignancy
Polycythaemia (high RBCs)
SLE
thrombophilia
What scoring system do you use for a PE and what is it made up of
Wells score
clinical signs/symptoms of DVT
PE is number 1 likely diagnosis
tachycardic
Immobilisation at least 3 days or surgery in previous 4 weeks
Previous diagnosed PE or DVT
Haemoptysis
Malignancy w treatment within 6 months
metabolic disturbance in a patient presenting with a PE
usually respiratory alkalosis because high RR causes them to blow off CO2
How to diagnose patient presenting with a PE
history
examination
CXR
Wells score - likely perform CTPA; unlikely perform D dimer and if positive perform CTPA
Initial management of patient with a PE
first line - apixaban or rivaroxaban
- LMWH an alternative or in antiphospholipid syndrome
- Should be started immediately before confirming diagnosis
Long term anticoagulation for patient with a PE
options: DOAC, warfarin or LMWH
INR for warfarin is 2-3
When do you thrombolyse PE patients
in massive PEs -> when they are haem-dynamically unstable
give streptokinase, alteplase or tenectplase
can be done peripheral IV or central catheter into pulmonary arteries
Causes of a pneumothorax
spontaneous
trauma
iatrogenic
lung pathologies -> infection, asthma or COPD
Investigations for a pneumothorax
CXR
CT if too small to see on CXR
Management of a patient with a pneumothorax and no SoB and <2cm rim of air on CXR
No treatment required as it will resolve spontaneously
follow up in 2-4weeks
Management of a pneumothorax with SoB and/or >2cm rim of air on CXR
- Aspiration followed by reassessment
- If aspiration fails twice then chest drain is required
Where is a chest drain inserted
- Inserted in the triangle of safety
- 5th intercostal space (inferior of the nipple line)
- Midaxillary line ( Lateral edge of latissimus Dorsi)
- Anterior axillary line (Lateral edge of pectoralis major)
Where is the needle inserted in a chest drain (in relation to the rib)
just above the rib to avoid the neurovascular bundle
Two complications of a chest drain
- Air leaks around drain site → indicated by persistent bubbling of fluid, particularly on coughing
- Surgical emphysema → (also known as subcutaenous emphysema) when air collects in subcut tissue
When would a pneumothorax require surgical intervention
- Chest drain fails to correct it
- Persistent air leak in the drain
- Pneumothorax recurs
Surgical options for a pneumothorax
- Abrasive pleurodesis(using direct physical irritation of the pleura)
- Chemical pleurodesis(using chemicals, such astalc powder, to irritate the pleura)
- Pleurectomy(removal of the pleura)
What is a tension pneumothorax
Caused by trauma to the chest wall that creates a one-way valve that lets air in but not out
Signs of a tension pneumothorax
- Tracheal deviation away from the side of the pneumothorax
- Reduced breath sounds on the side of the pneumothorax
- Increased resonance to percussion on affected side
- Tachycardia
- Hypotension
