Investigations + treatments Flashcards
(20 cards)
Blood tests ABG?
assess gas exchange to ensure they don’t go into resp failure.
Blood tests FBC?
WCC raised in infection, neutrophilia if it’s a bacterial infection
Blood tests CRP?
raised in infection.
Blood tests U&Es?
deranged if dehydrated and so hypoperfusing kidneys. Urea is an indicator of severity of pneumonia.
Blood tests blood cultures?
identify causative organism
CXR?
shows areas of consolidation
ECG?
must perform to rule out ischaemia or AF secondary to pneumonia. May also show right heart strain in COPD patients.
Microbiology urinary antigens?
pneumococcal and legionella antigens and tailor antibiotics
microbiology sputum cultures?
non-bronchoscopic bronchoalveolar lavage is better
CURB-65?
Patients with 2/5 should be admitted to hospital. Confusion (AMTS of <9), Urea >7mM, Resp rate of >30, BP <90 systolic / <60 diastolic, >65yrs old. Also account for comorbidities, suspicion of unusual organisms (pneumocystis in HIV+, Pseudomonas in cystic fibrosis patients).
Complications of pneumonia?
spread of infection (pleural effusion, empyema, abscess, septicaemia),
damage to local structures (bronchiectasis, pneumothorax)
3 most common causes of chronic cough in a non-smoker?
asthma, post-nasal drip, GORD.
Clinical features suggestive of asthma?
Wheeze, breathlessness, chest tightness, cough, worse at night, Triggered by exercise, allergen exposure, cold air or after taking aspirin or beta-blockers
Obstructive airway disease on a LFT?
(asthma, COPD) forced expiratory volume in 1 sec (FEV1) ratio to forced vital capacity (FVC) of <0.7.
Postnasal drip?
diagnosis of exclusion, confirmed by a trial of treatment (i.e. of inhalers don’t work, with antihistamines or nasal decongestants.
Treatment for GORD?
antacids, histamine H2 antagonists, PPIs.
20% of paients on ____ get a cough?
ACE inhibitors
Cause of Bovine cough?
recurrent laryngeal nerve palsy in cancer patients. Damage to the RLN can be by malignancy (Pancoast apical lung tumour) or surgey (neck surgery)
Why are COPD patients at risk of becoming hypoxaemic?
The airways contain mucus that impairs ventilation. The lungs are hyperventilated, making them less efficient at moving air. The hypoxic vasoconstriction mechanism is blunted (usually ensures that areas of the lung that are poorly ventilated are supplied with less blood so gas exchange only occurs in well ventilated areas). COPD patients aren’t given 100% O2 because they can become hypercapnic as giving O2 diminishes the hypoxic ventilation further, so blood is diverted away from areas still able to exchange gas.
Symptomatic cough treatment?
Antitussives (cough suppressants) can offer symptomatic relief.
Inhaled corticosteroids or oral antihistamines; suppress inflammation.
Inhaled ipratropium bromide; anticholinergic that blocks efferent limb of cough reflex.
