SoB and Respiratory Flashcards
contraindications to NIV
respiratory arrest/ need for immediate intubation
facial trauma/ abnormalities
fixed upper airway obstruction
severe vomiting
acute severe asthma
pneumothorax without chest drain
normal anion gap metabolic acidosis causes
GI bicarbonate loss: prolonged diarrhoea, fistula
renal tubular acidosis
drugs
Addison’s disease
raised anion gap metabolic acidosis causes
lactate: shock, sepsis, hypoxia
ketones: DKA, alcohol
urate: renal failure
acid poisoning: salicylates, methanol
metabolic alkalosis causes
vomiting/aspiration
diuretics
hypokalaemia
primary hyperaldosteronism
Cushing’s syndrome
bartter’s syndrome
congenital adrenal hyperplasia
respiratory acidosis causes
COPD
life-threatening asthma/ pulmonary oedema
sedative drugs: benzodiazepines, opiate overdose
respiratory alkalosis causes
psychogenic
hypoxia causing hyperventilation
early salicylate poisoning
CNS stimulation: stroke, SaH, encephalitis
pregnancy
bleeding diathesis
Bleeding diathesis refers to an increased susceptibility to bleeding or bruising. .
congenital causes of bleeding diathesis
vWD
haemophilia
ehlers danlos
digeorge
acquired causes of bleeding diathesis
vascular problems
decreased pt count
vitK deficiency
increased pt destruction
kidney failure
liver disease
anticoagulant therapy
acquired clotting factor antibody
adrenaline <6 months anaphylaxis
100-150micrograms
adrenaline 6 months- 6 years anaphylaxis
150 micrograms
adrenaline 6-12 years anaphylaxis
300 micrograms
adrenaline adults >12 anaphylaxis
500 micrograms
presentation of acute asthma attack
Dyspnoea
Coughing
Difficulty breathing
Wheeze
Chest tightness
moderate asthma features
Increasing symptoms
PEF >50-75%
No features of severe asthma
severe asthma features
PEF 33-50%
RR more than equals to 25
HR more than equals to 110
Inability to complete sentence in one breath
features of life-threatening asthma
PEF <33%
SO2 <92% or PO2 <8
Cyanosis
Hypotension
Exhaustion, altered consciousness
Silent chest
Tachyarrhythmias
criteria for asthma attack referral to intensive care
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
immediate management of asthma attack
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
management of life-threatening asthma
Inform the intensive care team
Magnesium sulphate 2g IV over 20 minutes
Nebulised salbutamol every 15min
management of asthma attack if no improvement
Nebulised salbutamol every 15min
Continue ipratropium 0.5mg 4-6hrly
Consider aminophylline unless already on theophylline
ITU transfer for invasive ventilation
monitoring of asthma attack
Peak flow measurement every 15-30min pre- and post-Salbutamol
SpO2: keep >92%
Consecutive Arterial blood gas measurements
management of COPD attack
oxygen therapy
steroids
nebulisted bronchodilators
antibiotics if evidence of infection
Further COPD treatments if no response (considering pre-morbid status)
Repeat nebulisers and consider aminophylline IV
Consider NIV (BiPAP) if pH <7.35 and/or RR >30
Consider invasive ventilation if pH<7.26
