what treatments would you discuss with them Flashcards
Moderate Asthma
Nebulised beta-2 agonists (i.e. salbutamol 5mg repeated as often as required)
Nebulised ipratropium bromide (sometimes with salbutamol)
Steroids. Oral prednisolone or IV hydrocortisone
Antibiotics if evidence of bacterial infection
Severe Asthma
Oxygen if required to maintain sats
Aminophylline infusion (smooth muscle relaxant)
Consider IV salbutamol
Life Threatening Asthma
IV magnesium sulphate infusion (bronchodilator)
Admission to HDU / ICU
Intubation in worst cases – however this decision should be made early because it is very difficult to intubate with severe bronchoconstrictio
COPD (maintainance)
First Line:
Short acting bronchodilators:
- beta-2 agonists (salbutamol or terbutaline) OR
- short acting antimuscarinics (ipratropium bromide).
Second Line:
- combined long acting beta agonist (LABA)
- plus a long acting muscarinic antagonist (LAMA) e.g. tiotropium
Pulmonary Embolism
Initial:
- apixaban or rivaroxaban
- LMWH when these arent suitable
Long Term:
- warfarin, DOACs, LMWH
Pneumothorax
If no SOB and small rim of air the chest xray then no treatment required as it will spontaneously resolve.
If SOB and/or there is a > 2cm rim of air on the chest xray then it will require aspiration and reassessment.
If aspiration fails twice it will require a chest drain.
Pleural Effusion
- ABCDE
- Treat underlying cause
- Intercostal drain for large pleural effusion or empyema
Bronchial Carcinoma
NSCLC:
- 1st line - lobectomy
- Curative radiotherapy
- Chemotherapy
SCLC:
- Palliative chemotherapy
consider personalised/ precision medicine
Pneumonia
Antibiotics- Penecillin, amoxicillin, vancomycin for Staph. aureus
IV crystalloid