Intro Wk: Resp Flashcards
What clinical signs should you enquire more about?
Plasters and IV infusions
Examination findings of pneumothorax
Trachea - deviated away
Expansion - reduced
Fremitus - decreased
Percussion - resonant
Auscultation - absent
How are pneumothoracies classified? (3)
Spontaneous: 1° w/o and 2° w underlying disease
Traumatic: blunt (closed), penetrating (open), iatrogenic
Tension: progressively inc pressure, cardioresp compromise, life threatening
Any type may lead to tension, clinical dx, medical emerg
Which drain do you use for pneumothoraces?
Just the underwater seal bottle
Describe bubbling and swinging wrt chest drains?
Bubbles - air is being expelled during expiration
Swinging - the fluid going up and down the tube during insp/exp
Swinging w/o bubbles shows all the air from the pneumothorax is out
If the drain doesn’t stop bubbling what does this suggest? And what should you do?
There’s a fistula -> requires specialist intervention
Examination findings of pleural effusion
Trachea - deviated away
Expansion - reduced
Fremitus - decreased
Percussion - stoney dull
Auscultation - absent
What does dec tactile vocal fremitus suggest?
Pleural effusion - liquid - absorbs sound
What is the g/L for both exudative and transudative pleural effusion?
Exudative: >35
Transudative: <25
Outline Lights criteria for exudative vs transudative pleural effusion
Any one of is exudative vs if none transudative:
Pleural:Serum Protein >0.5
Pleural:Serum LDH >0.6
Pleural Fluid LDH >2/3 upper limit of normal
List four exudative causes of pleural effusion (high protein content)
Infection, malignancy, pulmonary embolism, AI disease
List four transudative causes of pleural effusion (low protein content)
Congestive HF, hepatic cirrhosis, nephrotic syndrome, CKD
Patho of exudative pleural effusion
Inc capillary permeability
Patho of transudative pleural effusion
Inc capillary hydrostatic pressure
Dec capillary oncotic pressure
Which causes of pleural effusion a/w low glucose? (4)
MEAT
Malignancy
Empyema
Arthritis
TB
Which drain do you use for pleural effusions?
Both a trap bottle and underwater seal bottle
Examination findings of pneumonia
Trachea - central
Expansion - reduced
Fremitus - increased
Percussion - dull
Auscultation - bronchial
What does inc tactile vocal fremitus suggest?
Pneumonia - solid - conducts sound
Ix for suspected pneumonia
- Bloods: purple - FBC (raised WCC) and ESR & yellow - U+Es, LFTs, CRP (?sepsis)
- Imaging: CXR
- Sputum, blood cultures, MC&S -> start empirical abx
Alongside oxygen which abx are used to tx pneumonia?
CAP - Augmentin + Clarithromycin
HAP - Ciprofloxacin + Vancomycin
Adjust abx according to MC&S results ~2days after starting
Which abx does strep pneumoniae always respond to?
Penicillin
Which abx treats haemophilus influenzae?
Cefuroxime
Which drug commonly interacts w clarithromycin?
Warfarin
Which pneumonia causing pathogen is a/w recent viral infection?
Staph Aureus
