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RESP SYSTEM DEN303 > Resp Basics > Flashcards

Resp Basics Flashcards

1
Q

Features of an inspiratory wheeze?

A

Monophonic
upper airways
tracheal tumour/TB

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2
Q

Features of expiratory wheeze?

A

Polyphonic
Bronchoconstriction
Asthma

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3
Q

What is obstructive lung disease?

A

Narrowing of airways that prevents outflow from the lungs for gas exchange

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4
Q

Types of obstructive lung disease? Features?

A

Asthma - reversible airway obstruction - mast cell degranulation of histamine

CODP - Irreversible airway obstruction, long term smoking damage

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5
Q

What is SOB?

A

Difficulty breathing - use of accessory muscles and increased breathing rate
- ‘dyspnoea’

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6
Q

What make SOB worse?

A

Blood loss
Ventilation problem - Choking
Heart failure

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7
Q

Causes of SOB?

A

Lung problem:

  • Asthma
  • COPD
  • Pulmonary fibrosis
  • Interstitial lung disease
  • Pneumonia

Heart problem:

  • Failure = inadequate O2 supply
  • MI

Blood problem:

  • Anaemia (low Hb = low O2)
  • Diabetic ketoacidosis = fast breathing = retention of metabolic acid from ketones

Joint cardiac and resp problems:

  • Anxiety - fight/flight, hyperventilation, tachycardia
  • PE - ventilation/perfusion problem
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8
Q

What is the normal respiratory rate?

A

12-16 breaths/min

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9
Q

What resp rate indicates tachypnoea?

A

20 breaths/min

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10
Q

Criteria of an acute severe asthma attack?

A

Resp rate over 25/30 per min
Peak flow is 50% below expected
Cannot complete sentences
Hr >110/min

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11
Q

When does an asthma attack become life threatening?

A

PEF <33%
SpO2<92%
Cyanosis
Exhaustion

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12
Q

What is FEV1?

A

Forced expiratory volume over the 1st second of breathing out

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13
Q

What is FVC?

A

Forced vital capacity = vol of air that can be forcibly blown out after a full insp

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14
Q

What is the normal FEV1/FVC?

A

0.8 or more

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15
Q

What is the FEV1/FVC for obstructive disease?

What indicates asthma?

A

0.7 or less

Asthma needs to demo reversibility - give bronchodilator and repeat (if improves FEV1/FVC = asthmatic)

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16
Q

How to measure breathing?

A

Spirometer = measures volume breathed out in one forced breath (FVC)
Peak flow meter = breath out as far as you can as fast (how fast you breathe)

17
Q

How does an asthmatic’s breathing differ?

A

Cannot breathe out fast = peak flow (and FEV1) is lower but FVC is same

18
Q

What is a spirometer?

A

Measures volume of air breathed out in one forced breath (FVC)
(how much air)
Helps diagnose and monitor lung conditions
Compare results to someone their age, height and sex

19
Q

What is a peak flow meter?

A

Measures how fast someone can breathe out (PEF)
(how fast)
Helps diagnose asthma
Use at home twice daily when trying to diagnose asthma

20
Q

Characteristics of a restricted disease?

A 
Lower FVC (lower vol)
FEV1 = same
21
Q

Inhalers: What do relievers do? Examples?

A 
Manage attacks
Dilate bronchi to normal
Short acting beta agonists
Salbutamol
Ipratropium bromide
22
Q

Inhalers: What do preventers do? Examples?

A

Do not relieve attacks
Decrease number of attacks
Long acting beta agonists
Steroids - Beclometasone, budesonide, fluticasone

23
Q

What disorders require inhalers?

A

COPD and asthma

24
Q

What is resp failure I?

A

<8KPa PaO2
Low/normal PaCO2
Caused by pneumonia, asthma
Tx - give O2

25
Q

What is resp failure II?

A

<8PKa PaO2
>6KPa PaCO2
Caused by overdose, trauma, COPD, neuromuscular
Tx - give O2, care in chronic

26
Q

What drives normal breathing?

A

CO2 as adapting receptor (increase CO2 = breathe faster)

27
Q

What drives breathing in COPD?

A

O2 = non-adapting factor = lack of O2 to tissues

28
Q

Define COPD

A

Airway obstruction as bronchial tubes inflamed = trapped air in lungs = decrease FVC and low FEV1
= FEV1/FVC = less than 70%

29
Q

How to calculate if smoking is significant?

A

Cigarettes a day x number of years
Divided by 20
If more than 10PYH = significant

30
Q

Define asthma

A

Reversible airway obstruction due to crosslinking of receptor bound IgE antibodies = mast cell degranulation of histamine =

  • Mucus hypersecretion
  • Mucus plugging
  • Mucosal oedema
  • Bronchoconstriction
31
Q

What questions to ask when assessing asthma control?

A 
Meds
Last A&amp;E visit for asthma attack
ITU
Freq of attacks
Func limitations
32
Q

What is the acute tx for asthma?

A

Salbutamol through an O2 spacer (2 puffs)
Systemic corticosteroids
Ipatropium bromide

33
Q

Long term asthma tx?

A

Inhaled steroids

34
Q

How is asthma linked to dentistry?

A

Anxiety = asthma
Inhaled allergens in practise
Knowledge before tx = emergency prep
Chronic use of bronchodilating inhalers and/or glucocorticoids = increase oral candidiasis

35
Q

How to manage asthma?

A

ABC approach and monitoring
Salbutamol - how, spacer, how much
O2 - what rate, 15 litres per min for 4 hrs

Ambulance - if hypoxic, acute severe asthma or after initial therapy

In hospital:
- High flow O2
- Nebulisers - flow of O2 and add liquid of: salbutamol 5mg, ipratropium bromide 0.5mg
Prednisolone 40mg PO
= prevents late T cell response the next day

No response to nebulisers/life threatening:

  • Mg
  • Aminophylline - can cause arrhythmia
36
Q

What is the BTS approach?

A
  1. SABA (salbutamol, terbutaline)
  2. Inhaled steroid (beclomethasone = brown inhaler)
  3. LABA (salmeterol)
  4. Antileukotrines
  5. Oral steroids (prednisolone)
37
Q

How to treat asthma?

A

If PEF less than 75% = short acting bronchodilator
4 puffs via spacer then 2 puffs/2mins for up to 10 puffs
OR
salbutamol 5mg nebuliser (ideally by 6L/min O2)
Consider oral steroids and referral to GP

38
Q

How to treat COPD?

A

If SOB/wheezy
- Salbutamol ventolin 5mg dose and ipratropium bromide 500mg via nebuliser (if not to hand = 4 puffs of short acting beta agonist via spacer)

If infective exacerbation - lower resp tract infec:

  • Aminopenicillin
  • Tetracycline
  • Macrolide
39
Q

How to give O2?

A

Initially: nasal cannulae 2-6L/min or simple face mask 5-10l/min

Pt not at risk of hypercapnic resp failure who have saturation <85% = reservoir mask at 10-15l/min

Recommended initial O2 saturation rate = 94-98%

RESP SYSTEM DEN303 (7 decks)

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