Other respiratory Flashcards
(41 cards)
In what pH range are people likely to benefit from NIV?
7.25-7.35
What is a blood contraindication for chest drain insertion?
INR >1.3
What can worsen a tension pneumothorax?
ventilation through endotracheal tube
NRT (ADR, use)
- nausea and vomiting, headaches and flu-like symptoms
- nicotine patches + another form of NRT e.g. gum, inhalator, nasal spray) if high level of dependence
Varenicline (MOA, ADR, CONTRA)
- nicotinic receptor partial agonist
- more effective than bupropion
- ADR: nausea, insomnia, headache, abnormal dreams
- caution if depression or self harm
- CONTRA in breast feeding and pregnancy
Bupropion (MOA, ADR, CONTRA)
- norepinephrine and dopamine reuptake inhibitor, nicotinic antagonist
- small risk of seizures
- CONTRA: epilepsy, pregnancy and breast feeding
Smoking cessation in pregnancy:
- CBT
- NRT if failure
When should oxygen therapy be administered:
- critically ill (anaphylaxis, shock etc)
- reservoir mask 15L/min
Oxygen target sats in oxygen therapy:
- acutely ill: 94-98%
- patients at risk of hypercapnia (e.g. COPD): 88-92%
- reduce in stable patients with satisfactory sats
Oxygen therapy in COPD patients:
- prior to blood gases, 28% venturi mask at 4L/min and aim for 88-92%
- with risk factors for hypercapnia and no Hx of respiratory acidosis
- adjust range to 94-98% if pCO2 normal
Situations where oxygen therapy should not be routinely used if no evidence of hypoxia:
- MI or ACS
- stroke
- obstetric emergencies
- anxiety-related hyperventilation
Common causes of lobar collapse:
- lung cancer
- asthma (mucous plugging)
- foreign body
CXR signs of lobar collapse:
- tracheal deviation towards
- mediastinal shift towards
- elevation of hemidiaphragm
Causes of obstructive lung disease:
- asthma
- COPD
- bronchiectasis
- bronchiolitis obliterans
Causes of restrictive lung disease:
- pulmonary fibrosis
- asbestosis
- sarcoidosis
- ARDS
- infant RDS
- kyphoscoliosis e.g. ankylosing spondylitis
- neuromuscular disorders
- severe obesity
Respiratory manifestations of RA:
- pulmonary fibrosis
- pleural effusion
- pulmonary nodules
- bronchiolitis obliterans
- complications of drug therapy e.g. methotrexate pneumonitis
- pleurisy
- Caplan’s syndrome - massive fibrotic nodules with occupational coal dust exposure
- infection secondary to immunosuppression
Key indications NIV:
- COPD with respiratory acidosis pH 7.25-7.35
- type II RF secondary to chest wall deformity, neuromuscular disease or OSA
- cardiogenic pulmonary oedema unresponsive to CPAP
- weaning from tracheal intubation
Kartagener’s
- primary ciliary dyskinesia
- dextrocardia/complete situs inversus (quiet heart sounds, small volume complexes in lateral leads)
- bronchiectasis
- recurrent sinusitis
- subfertility (diminished sperm motility and defective ciliary action in fallopian tubes)
Contraindications to chest drain insertion:
- INR >1.3
- platelet count <75
- pulmonary bullae
- pleural adhesions
Where should a chest drain be inserted?
5th intercostal space in midaxillary line
Complications of chest drain insertion:
- failure of insertion
- bleeding
- infection
- penetration of lung
- re-expansion pulmonary oedema
What is re-expansion oedema:
- preceded by onset of cough or SOB
- avoid by clamping tube regularly in event of rapid fluid output (should not exceed 1 L over less than 6 hours)
How can you confirm the position of the chest tube?
- aspiration of fluid from drainage tube
- swinging of fluid within drain tubing when patient inspires and on XR
Examples of extrinsic allergic alveolitis:
- bird fancier’s lung
- farmer lung
- malt workers’ lung: aspergillum clavatus
- mushroom worker’s lung: thermophilic actinomycetes
