Stage 8

Question 1

1. Define Asthma:

Answer 1

Inflammatory disease with airway hyper responsiveness.
Syndrome characterised by cough, wheezing, breathlessness and chest tightness initiated by allergens, infection or other pollution.

Question 2

2. Pathophys of asthma:

Answer 2

• Exposure to allergen/trigger
• Inflammatory response: 1. bronchospasm 2. mucosal oedema (increased vascular permeability and vasodilation) 3. mucous plugging
• Small airway obstruction
• Air trapped - increased resistance and decreased expiratory air flow
• Increased accessory muscle use - respiratory fatigue
• Gas trapping increased intrathoracic pressure, compressing SVC and IVC - reduced CO
• V/Q mismatch - hypoxaemia

Question 3

3. S/Sx of asthma:

Answer 3

• Wheezing - mild = end expiratory, severe = throughout, or brick bag
• Coughing, SOB, chest tightness/pain

Question 4

4. APO definition:

Answer 4

Fluid leaks from pulmonary capillary network into the lung interstitium and alveoli, impairing the ability of the lymphatics to clear the fluid.

Question 5

5. APO causes:

Answer 5

• AMI/HT/mitral valve disease/cardiomyopathy/dysrhtymias
• Acute inflammation
• Poisoning with gases (chlorine)
• Pulmonary aspiration of gastric juices
• Excessive volume overload
• Some types of cerebral damage
• Smoke inhalation

Question 6

6. LVF to APO pathophys:

Answer 6

• LV fails to contract forcefully enough to maintain adequate CO, SV and ejection fractions
• Increase in LV pressures
• Backlog of pressure in pulmonary circulation
• Hydrostatic pressure overcomes oncotic pressure and Na and H20 forced into interstitium of the lungs
• Fluid invades alveoli decreasing gas exchange
• Leads to hypoxaemia

Question 7

7. S/Sx of APO:

Answer 7

• Severe respiratory distress
• Cough
• Agitation
• Confusion
• Paroxysmal nocturnal dyspnoea
• Cyanosis
• Diaphoresis
• Bilateral crackles/crepitations
• Wheeze
• Increased resp rate
• Tachycardia
• Possible hypertension

Question 8

8. Rx for APO:

Answer 8

• Position
• 8L/min O2
• Pt with sats<90% may require PEEP ventilations with BVM
• If ACS - immediately commence O2 at max rate via BVM - activate ALS