Acute respiratory infections

Question 1

ABCDE: Airway

Answer 1

• Ensure patient can speak to you
• Listen for added inspiratory sounds
• Administer oxygen

Question 2

ABCDE: Breathing

Answer 2

• Check respiratory rate + oxygen sat.
• Check for tracheal deviation + lung expansion
• Percuss chest + auscultate

Question 3

ABCDE: Circulation

Answer 3

• Check blood pressure, HR and pulse
• Obtain IV access - 2 large-bore cannulas
• Administer bolus of IV fluid

Question 4

ABCDE: Disability

Answer 4

• AVPU - measure consciousness
• Check blood glucose
• Examine for photophobia + neck stiffness

Question 5

ABCDE: Exposure

Answer 5

• Check temperature
• Examine throughly for rashes
• Palpate abdomen

Question 6

Signs of HYPOVOLAEMIA

Answer 6

• Low blood pressure
• Increased cap refill time
• Decreased consciousness
• Oliguria/anuria

Question 7

Decreasing infection: (4)

Answer 7

• Hand hygeine
• Personal protective equipment
• Environment
• Equipment

Question 8

Influenza: Overview

Answer 8

Influenza is highly-contagious. Individuals can be infectious for 24 hours to 48 hours prior to developing symptoms but some never develop symptoms at all.

PERSON-TO-PERSON spread occurs through:

• Direct contact with infectious individuals
• Contact with contaminated surfaces (fomites)
• Inhalation of infectious aerosol

Question 9

ANTIGENIC drift: Definition

Answer 9

Antigenic drift – gradual accumulation of mutations that change the surface antigens and make the virus less susceptible to the antibodies produced during previous infections.

Question 10

ANTIGENIC shift: Definition

Answer 10

Antigenic shift – two or more strains combine to form a new subtype with surface antigens that humans have not encountered previously.

Question 11

UNCOMPLICATED influenza: Definition

Answer 11

Uncomplicated influenza: Influenza presenting with fever, coryza, generalised symptoms (headache, malaise, myalgia, arthralgia) and sometimes gastrointestinal symptoms, but without any features of complicated influenza.

Question 12

COMPLICATED influenza: Definition

Answer 12

Complicated influenza: Influenza requiring hospital admission and/or with symptoms and signs of lower respiratory tract infection (hypoxaemia, dyspnoea, lung infiltrates), central nervous system involvement and/or a significant exacerbation of an underlying medical condition.

Question 13

Risk factors for COMPLICATED influenza

Answer 13

• Neurological, hepatic, renal, pulmonary and chronic cardiac disease
• Diabetes mellitus
• Immunosuppression
• Age over 65 years
• Pregnancy (including up to two weeks post partum)
• Morbid obesity (BMI >=40)

Question 14

Diarrhoea: Overview

Answer 14

• Common presentation amongst patients of all ages.
• Can have infective and non-infective.
• History = important in differentiating between the two.
• Infective diarrheoa can contain blood or mucous, be profuse and watery, and the patient may also have signs of being systemically unwell, with fever and joints pains.
• Non infective diarrhea is not accompanied by systemic illness, but the patient can present dehydrated and still need medical attention.
• Medical emergencies such as ischaemic bowel can also present with diarrhea.

A thorough diet history is also needed as certain foods including raw meat and dairy products can be associated with infective diarrhea.

Question 15

INFECTIVE Diarrhoea:

• Causes
• At risk

Answer 15

Infective diarrheoa can be caused by bacteria, viruses and parasites.  
Causes:
- Bacteria
- Viruses
- Parasites

At risk patients include:

• Recent travelers
• Immunosuppressed
• Care, nursing home
• Hospital patients