SoB and Respiratory

Question 1

contraindications to NIV

Answer 1

respiratory arrest/ need for immediate intubation
facial trauma/ abnormalities
fixed upper airway obstruction
severe vomiting
acute severe asthma
pneumothorax without chest drain

Question 2

normal anion gap metabolic acidosis causes

Answer 2

GI bicarbonate loss: prolonged diarrhoea, fistula
renal tubular acidosis
drugs
Addison’s disease

Question 3

raised anion gap metabolic acidosis causes

Answer 3

lactate: shock, sepsis, hypoxia
ketones: DKA, alcohol
urate: renal failure
acid poisoning: salicylates, methanol

Question 4

metabolic alkalosis causes

Answer 4

vomiting/aspiration
diuretics
hypokalaemia
primary hyperaldosteronism
Cushing’s syndrome
bartter’s syndrome
congenital adrenal hyperplasia

Question 5

respiratory acidosis causes

Answer 5

COPD
life-threatening asthma/ pulmonary oedema
sedative drugs: benzodiazepines, opiate overdose

Question 6

respiratory alkalosis causes

Answer 6

psychogenic
hypoxia causing hyperventilation
early salicylate poisoning
CNS stimulation: stroke, SaH, encephalitis
pregnancy

Question 7

bleeding diathesis

Answer 7

Bleeding diathesis refers to an increased susceptibility to bleeding or bruising. .

Question 8

congenital causes of bleeding diathesis

Answer 8

vWD
haemophilia
ehlers danlos
digeorge

Question 9

acquired causes of bleeding diathesis

Answer 9

vascular problems
decreased pt count
vitK deficiency
increased pt destruction
kidney failure
liver disease
anticoagulant therapy
acquired clotting factor antibody

Question 10

adrenaline <6 months anaphylaxis

Answer 10

100-150micrograms

Question 11

adrenaline 6 months- 6 years anaphylaxis

Answer 11

150 micrograms

Question 12

adrenaline 6-12 years anaphylaxis

Answer 12

300 micrograms

Question 13

adrenaline adults >12 anaphylaxis

Answer 13

500 micrograms

Question 14

presentation of acute asthma attack

Answer 14

Dyspnoea
Coughing
Difficulty breathing
Wheeze
Chest tightness

Question 15

moderate asthma features

Answer 15

Increasing symptoms
PEF >50-75%
No features of severe asthma

Question 16

severe asthma features

Answer 16

PEF 33-50%
RR more than equals to 25
HR more than equals to 110
Inability to complete sentence in one breath

Question 17

features of life-threatening asthma

Answer 17

PEF <33%
SO2 <92% or PO2 <8
Cyanosis
Hypotension
Exhaustion, altered consciousness
Silent chest
Tachyarrhythmias

Question 18

criteria for asthma attack referral to intensive care

Answer 18

Requiring ventilatory support
With acute severe or life-threatening asthma who is failing to respond to therapy, as evidenced by:
Deteriorating peak flow reading
Persisting or worsening hypoxia
Hypercapnia
Exhaustion, feeble respiration
Respiratory arrest

Question 19

immediate management of asthma attack

Answer 19

Sit-up
100% O2 via non-rebreathe mask (aim for 94-98%)
Nebulised salbutamol (5mg) and ipratropium (0.5mg)
Hydrocortisone 100mg IV or prednisolone 50mg PO

Question 20

management of life-threatening asthma

Answer 20

Inform the intensive care team
Magnesium sulphate 2g IV over 20 minutes
Nebulised salbutamol every 15min

Question 21

management of asthma attack if no improvement

Answer 21

Nebulised salbutamol every 15min
Continue ipratropium 0.5mg 4-6hrly
Consider aminophylline unless already on theophylline
ITU transfer for invasive ventilation

Question 22

monitoring of asthma attack

Answer 22

Peak flow measurement every 15-30min pre- and post-Salbutamol
SpO2: keep >92%
Consecutive Arterial blood gas measurements

Question 23

management of COPD attack

Answer 23

oxygen therapy
steroids
nebulisted bronchodilators
antibiotics if evidence of infection

Question 24

Further COPD treatments if no response (considering pre-morbid status)

Answer 24

Repeat nebulisers and consider aminophylline IV
Consider NIV (BiPAP) if pH <7.35 and/or RR >30
Consider invasive ventilation if pH<7.26