TOSCE Flashcards
List some uses of NIPPV
COPD exacerbation Acute pulmonary oedema Acute hypoxaemic respiratory failure Acute exacerbation of asthma/cf Acute respiratory failure in the immunocompromised
Contraindications to NIPPV
Haemodynamic instability
GCS<10
Inability to cooperate
Cardiac arrest
Unstable arrhythmia
Respiratory arrest
Upper airway obstruction
Unprotected airway
High aspiration risk Inability to clear secretions Facial trauma/deformity Neurological surgery Facial surgery
pH 7.27 (7.35 - 7.45)
paCO2 14.4 ka (4.7- 6 kPa)
paO2 6.9 kPa (11 – 13 kPa)
HCO3 30 (22-26 mmol/L)
Describe this ABG result.
Acidotic hypercapnic respiratory failure/Type 2 respiratory failure with partial metabolic compensation suggesting a component of chronicity to hypercapnoea.
Emphysema
Emphysema is a chronic permanent dilatation of the airways distal to the terminal bronchioles resulting in a gradual destruction of the alveolar septa leading to a decreased ability to oxygenate the blood.
chest exam finding of patient with COPD
Decreased chest expansion Hyperresonant percussion note Decreased breath sounds Wheeze Crepitations
when do you give NIPPI in COPD
NIPPV, if two of:
Moderate to severe dyspnoea
pH <7.35, Pco2>4.5
RR>25
List some complications of NIPPV
Skin irritation/breakdown/infection Discomfort Mask leaks Eye irritation Sinus pain/congestion Abdominal discomfort Nosocomial pneumonia Pneumothorax
complication of NSCLC
- Pleural effusion
- Post-obstructive pneumonia
- PE
- Pericardial effusion
- SVC obstruction
- Metastases (brain, bone, liver, adrenal)
SVC obstruction why a complication in lung cancer
syndrome may be due to compression of the superior vena cava by tumour or mediastinal lymph nodes or thrombosis
treatment of systemic scl
Treatment of localized sclerotic skin ultraviolet-A (UVA) light therapy, potent topical glucocorticoids, calcipotriol (a vitamin D analog), and methotrexate
