Management summary Flashcards
1) SABA
2) Inhaled Corticosteroid
3) Enhance dose/muscarinic antagonist
4) Oral Steroid + Specialist referral
Chronic Asthma
1) History - baselines, current medication, past episodes
2) Salbutamol + ICS 14 days
Mild Asthma Exacerbation
1) History - baselines, current medication, past episodes
2) O2
3) Salbutamol (Neb) + Hydrocortisone (IV)
4) Ipratropium (Neb) + Magnesium (IV)
Severe Asthma Exacerbation
1) History - baselines, current medication, past episodes
O SHIT ME
2) O2
3) Salbutamol (Neb) + Hydrocortisone (IV)
4) Ipratropium (Neb) + Theophylline (Neb)
5) Magnesium (IV) + Escalate
Life threatening Asthma Exacerbation
Home: Prednisolone 30mg OD 7-14 days, SABA inhaler + Antibiotics (if bacterial)
Hospital: Neb Salbutamol (5mg/4hrs) + Ipratropium (500mcg/6hrs), Antibiotics
ICU: IV Xanthine bronchodilation (e.g. theophyline), ventilation on ICU
Acute COPD exacerbation
1) No Dyspnoea AND Width <2cm (demarcation) at hilum = review in 2-4 weeks
2) Dyspnoea AND/OR >2cm width = aspiration + reassess, fail = chest drain.
1ary Pneumothorax
> 50 + >2cm width = chest drain
<2cm width = aspiration, fail = chest drain
<1cm = O2 + 24h monitor
2ndary Pneumothorax
1) Large Bore Cannula into 2nd ICS, mid clavicular line = relieve pressure
2) Chest Drain into ‘safe triangle’.
(5th ICS, Ant + mid axillary lines)
Tension Pneumothorax
Oral Amoxicillin - 5 days
Amoxicillin + Clarithromycin 7-10 days
Low + moderate severity Pneumonia.
1) Treat the underlying cause
2) Assess size/severity (symptomatic)
3) Conservative if small
3. 5) Chest Drain (symptomatic), Recurrent = Pleurodesis (sealing of pleural activity)
Pleural Effusion
1) Supportive (poor prognosis): O2 home therapy, flu + pneumococcal vaccine, palliative care planning.
2) Lung transplant - risk assess
ILD
1st line: Bisphosphonates + oral steroids 6-24 months
2nd line: Methotrexate OR azathioprine
Lung Transplant if needed
Severe Sarcoidosis
IV prostanoids, Endothelin receptor antagonists + PDE-5 inhibitors?
Severe Pulmonary Hypertension
