Topic 3 - Dyspnoea Flashcards
5 main causes of dyspnoea
- Neurological
- Airway obstruction
- Respiratory compromise
- Cardiovascular compromise
- Thoracic muskuloskeletal compromise
Mild (partial) airway obstriction management
- Reassurance
- Encourage spontaneous efforts to clear airway
- Inappropriate or premature intervention can result in severe or complete obstruction
Severe airway obstruction management (concious)
- Up to five sharp back blows
- Up to five chest thrusts
- Repeat if required
- Ensure ongoing assessment of airway and concious state
Severe airway obstraction (unconcious)
- Remove foreign body under direct visualisation
If not:
- O2
- Gentle IPPV
- LMA/ETT
- Appropriate resuscitation
Croup and clinical manifestations
Croup is a viral ilness that causes inflammatory oedema of the subglottis
- Coroyzal prodrome (URTI), hoarse voice, inspiratory stridor, harsh ‘barking’ cough, widespread wheeze, increased WOB and fever
- Affects children 6mths to 3 years generally
- 2-5 day symptoms, worse at night
- NOTE - nebulised adrenaline is a temporising measure only
Croup - differential diagnosis
- Inhaled foreign body
- Epiglottitis
- Bacterial tracheitis
4 components of bronchospasm in asthma
- Bronchospasm
- Inflammation and oedema of airways
- Mucous plugging
- Airway smooth muscle hyperplasia and hypertrophy
Asthma classifications
- Mild, moderate, severe, life-threatening
- Gradual onset
- Over days or weeks - higher mortality - responds less well to treatment
- Rapid onset
- Often has a precipitating trigger and responds quickly to treatment
Electrolyte complications of asthma
- Hypokalemia
- Hypocalcemia
- Lactic acidosis
Risk factors for life-threatening exacerbations in astma
- Prior ICU admission and prior intubation
- Three or more admissions to hospital over the last 12/12
- Currently taking steroids for asthma
- Poor compliance with medications
- NOTE - SpO2 is a POOR indicator of severity - will not decrease until later stages
Important patient history factors in asthma
- Previous asthma history (including ICU admissions and intubations, number of admissions in the last 12 months etc.)
- Co-existing medical conditions
- Asthma triggers if known and cause of current episode
- Duration of symptoms (? physical exhaustion)
- Medication use and compliance
IPPV in asthma
- Prolonged expiratory phase
- ADULT: 4-6 b/m
- LARGE CHILD: 8-10 b/m
- SMALL CHILD: 10-15
- INFANT:15-20
Asthma Managment
Main causes of cardiogenic APO
- Left ventricular failure (LVF)
- Increased intravscular volume
- Pulmonary venous outflow ovstruction (eg. mitral valve stenosis)
Main causes of non-cardiogenic APO
- High output states such as:
- Septicemia
- Anaemia
- Thyrotoxicosis
- Systemic increased vascular permiability
- Pancreatitis
- Eclampsia
- DIC
- Burns
- Toxins/environmental
- Submersion
- Toxic inhlation
- HAPE
- Other
- Head injury
- PE
Clinical featured of APO
- Crackles at bases, progressing to higher fields as progresses
- Pink, frothy sputum is severe cases
- Respiratory distress
- JVD
APO management
COPD and exacerbation management
Anaphylaxis definition
Any acute onset illness with typical skin features plus involvement of respiratory and/or cardiovascular and/or persistent severe gastrointestinal symptoms OR any acute onset of hypotension or bronchospasm or upper airway obstruction where anaphylaxis is considered possible
Resolved anaphylaxis and transportation
Due to possibility of byphasic response, all patients should be transported to a medical facility
Anaphylaxis management
Salbutamol (Pharmacology)
- B2 agonist
- Lowers serum potassium levels via direct stimulation of the sodium/potassium ATPase pump
Salbutamol (Indications)
- Bronchospasm
- Suspected hyperkalemia (with QRS widening AND/OR AV dissasociation)
Salbutamol (Contraindications)
- KSAR or hypersensitivity to salbutamol
- Patients <2 years old
Salbutamol (Precautions)
- APO
- IHD
Salbutamol (Side Effects)
- Anxiety
- Tachyarrhytmias
- Tremors
- Hypokalemia and metabolic acidosis
Salbutamol half-life
1.6 hours
Ipratropium Bromide (Pharmacology)
- Inhibits cholinergic vasomotor tone by decreasing intracellular intracellular Ca2+ (blocks acetylcholine)
Ipratropium Bromide (Indications)
- Moderate OR severe bronchospasm
Ipratropium Bromide (Contraindications)
- KSAR or hypersensitivity to anticholinergics
- Patients <2 years
Ipratropium Bromide (Precautions)
- Glaucoma
Ipratropium Bromide (Side Effects)
- Dilated pupils
- Dry mouth
- Palpitations
Laryngoscopy contraindications
- Suspected or known epiglottitis
Laryngoscopy complications
- Laryngospasm
- Hypoxia due to ventilation delay
- Upper airway and mouth trauma
- Exacerbation of underlying c-spine injury
- Vomiting
CPAP - mechanism
Increases intrathoracic pressure to decrease venous return and decrease preload, afterload and improve cardiac function
CPAP contraindications
- Patients <16
- GCS <9
- Inadequate ventilatory drive
- Hypotension
- Pneumothorax
- Facial trauma
- Epistaxis
CPAP complications
- Aspiration
- Gastric distension
- Hypotension
- Corneal driving
- Barotrauma
