11 Flashcards
(31 cards)
What are the cardinal signs and symptoms of respiratory disease?
-breathlessness Chest pain -coughing -haemoptysis -discoloured sputum -breath sounds
See signs and symptoms slide 4
What factors would you look at for breathlessness (dyspnoea)?
- it is very subjective
- common to all resp conditions
- look at onset, time and duration
- precipitating factors: position, weather, triggers, pets and other allergies
- progression
- severity: how bad is it? What does it stop you from doing such as walking?
See signs and symptoms slide 5-6
What are some potential causes of chest pain?
- mediastinal structures: ACS, pericarditis, aortic dissection, GORD
- pleura: infection, pneumothorax, PE (which may cause an infarct)
- chest wall: rib fracture (may allow for infection), Costochronitis, shingles
See signs and symptoms slide 7
How would you determine the cause of chest pain?
- central vs non-central
- cardiac vs “pleuritic”
- pleuritic pain: thoracic wall or shoulder tip, sharp and well localized, worse with coughing and breathing in
- cardiac: dull, worse upon breathing in
See signs and symptoms slide 8
What is cough?-
- important protective mechanism
- short, explosive expulsion of air
- triggered by any source of irritation
See signs and symptoms slide 10
What are the characteristics of cough?
- productive cough: what is the colour, amount, is there blood?
- character: bullvine vs. Seal-like
- timing: worse at night, or dependant on seasons?
- commonest cause is URTI
See signs and symptoms slide 12
What is productive cough?
- sputum and haemoptysis
- chronic bronchitis and COPD; clear sputum
- infection: yellow/green sputum
- bronchiectasis: large amount of yellow/green sputum
- haemoptysis: RED flag
See signs and symptoms slide 13-14
What is wheeze?
- high-pitched, “musical”
- mostly on expiration
- narrowing in intrathoracic airways
- narrowing exacerbated during expiration
- only audible with stethoscope
See signs and symptoms slide 15
What is stridor?
- high pitch, constant, loud
- more concerning
- mostly on inspiration
- mainly affects trachea and larynx in narrowing
- narrowing exacerbated during inspiration
- often audible WITHOUT stethoscope
See signs and symptoms slide 16
What would you inspect during a respi examination?
- raised RR
- clubbing
- cyanosis
- barrel shaped chest
- pursed lip breathing
See signs and symptoms slide 20-24
How would you palpate on a resp examination?
- tracheal position
- chest expansion: symmetrical?
See signs and symptoms slide 25
What would you percussion in a respiratory examination?
- resonant: normal
- hyper-resonant: increased air
- dull: consolidation
- stony-dull: pleural effusion
See signs and symptoms slide 26
How would you auscultation on a resp examination?
- normal (vesicular): “rustling leaves”
- bronchial: very harsh sound
- reduced or absent
Added sounds
- wheeze or stridor
- crackles: fine or course
- pleural rub: scratching, coarse sound
See signs and symptoms slide 27-28
What is a pulmonary embolism?
- obstruction of a pulmonary arter y or one of its branches, usually by a blood clot
- blood clot has become dislodged and been carried to the lungs by the blood stream
See lecture 11.2 slide 2
How would a pt. With fat embolism present?
- due to multiple trauma including long bone fractures
- donut-sign on CXR
- diffuse air space opacities/infiltrates bilaterally
- clinical signs may include petechiae rash, tachycardia, fever, hypoxaemia (may be refractory to O2)
- fat embolism syndrome: triad of lung, brain and skin
See lecture 11.2 slide 3
Describe cerebral air embolism
- usually iatrogenic occurring especially in patients
- air entry through central venous cannula, pulmonary artery catheters or haemodialysis catheters
See lecture 11.2 slide 4
What are risk factors of thromboembolism?
- virchow’s triad
- endothelial injury
- stasis or turbulence of blood flow
- blood hypercoaguability
- pregnancy
- prolonged immobilization
- previous VTE
- contraceptive pill
- long haul travel
- cancer
- heart failure
- obesity
- surgery
- HRT
- thrombophilia
See lecture 11.2 slide 7-9
In what instance will you get hypercoagulable conditions?
- antithrombin III deficiency
- protein C or protein S deficiency
- Factor V Leiden mutation is the most COMMON
- lupus anticoagulant
- homocystinuria
- occult neoplasm
- CT disorders such as RA
See lecture 11.2 slide 9
What is the pathophysiology of the clinical outcomes in PE?
- acute RV overload
- resp failure
- pulmonary infarction
See lecture 11.2 slide 10-11
What are the symptoms of PE?
- dyspnoea
- pleuritic chest pain
- substernal chest pain
- cough
- haemoptysis
- syncope
- unilateral leg pain
- fever of less than 39 C
See lecture 11.2 slide 11
What are the physical signs of PE?
- tachypnea
- rales or decreased breath sounds
- accentuated second heart sound
- tachycardia
- fever
- diaphoresis
- clinical signs/symptoms suggesting thrombophlebitis
- lower extremity oedema
- cardiac murmure
- cyanosis
See lecture 11.2 slide 12
What investigations would you do for a PE?
- blood gases
- CXR: to rule out other things
- ECG: to rule out other things
- d-dimer: look at likelihood and Well’s criteria
See lecture 11.2 slide 13-16
What imaging would you use for PE?
- pulmonary angiography
- ventilation perfusion lung scintigraphy in history!
- CT pulmonary angiography
See lecture 11.2 slide 17
How would you treat PE?
- GIVE OXYGEN
- immediate heparinisation
- heparin because easier to control, works better, fewer side effects
See lecture 11.2 slide 17
