Acute Breathlessness Flashcards
(25 cards)
What are the types of spontaneous pneumothorax?
Primary (no underlying lung disease) and secondary (lung disease or significant smoking history present).
What kind of pain is experienced in pulmonary embolism?
Pleuritic chest pain.
What drug should be given to a patient with suspected pulmonary embolism whilst investigations are underway?
Enoxaparin (clexane) to reduce and prevent blood clotting.
What are the cardinal features of a pulmonary embolism? (5)
Dyspnoea, chest pain, cough, haemoptysis, features of DVT.
When should the National Early Warning Score 2 (NEWS2) be used?
Patients over 16 for emergency, inpatient or prehospital initial assessment.
What pneumonics should be used to study chest x-rays?
Rotation
Inspiration
Picture
Exposure
Airway
Breathing
Circulation
Diaphragm
Everything else/extra tubes
What are the three cardinal features (signs) of anaphylaxis and what are they caused by? (3)
-Stridor - caused by laryngeal oedema.
-Wheeze - caused by bronchospasm due to histamine binding to H1 receptors in the lungs.
-(Pre)Syncope - caused by hypotension due to leaky capillaries.
What is anaphylaxis?
A life-threatening type 1 hypersensitivity reaction.
What is involved in a type 1 hypersensitivity reaction?
Mast cells pre-sensitised with IgE antibodies meet the antigen they have been pre-sensitised to, causing degranulation and massive histamine release.
What dose of adrenaline should be given to a patient in anaphylaxis?
Their own EpiPen dose OR 0.5mL of 1:1000.
Name three crystalloid fluids.
Saline, Hartmann’s, Plasma-Lyte.
What are the pharmacological treatment options for confirmed pulmonary embolism (PE)? (3)
-Offer DOAC (apixaban or rivaroxaban) first line.
-If these are not suitable, heparin (LMWH) for at least 5 days followed by dabigatran or edoxaban, or LMWH concurrently with a VKA (warfarin) till therapeutic anticoagulation is achieved.
What does a high pitch wheeze on inspiration (stridor) indicate?
Highly indicative of an upper airway obstruction.
How are smoking pack years calculated?
pack years = (cigarettes smoked per day/20) x no. years smoking
What is normal capillary refill time?
Blood should return to fingertip in less than 2 seconds after being pressed for 5 seconds.
What are blebs and bullae?
Blebs = small air-filled blisters that can form on surface of lung.
Bullae = pockets of air that can form within lung tissue.
What are four respiratory diseases associated with finger clubbing?
Bronchiectasis
Lung cancer
Cystic fibrosis
Pulmonary fibrosis
What are three causes of asterixis (flapping tremor)?
CO2 retention (i.e in COPD)
Uraemia
Hepatic encephalopathy
What is a deep sulcus sign in a chest x-ray?
A deepening in the costophrenic angle as an indicator of pneumothorax.
How are pneumothoraxes classified by size?
Measure the width of rim of air at level of hilum: <2cm is small, >2cm is large.
What are the three cardinal signs of pulmonary embolism?
Dyspnoea, tachypnoea and pleuritic chest pain.
What is a Wells Score?
A list of features that, if present, add up to a total clinical probability score stating risk of pulmonary embolism. [>5 = indicates PE].
What immediate treatment should be given to pulmonary embolism patients in haemodynamic collapse?
Thrombolysis with tissue plasminogen activator (tPA).
What is the pulmonary embolism severity index (PESI) score?
A risk stratification tool that has been externally validated to determine mortality and outcome of patients with newly diagnosed PE. [Low risk < 85]
