1. remove cap and shake 2. breath out 3. put mouthpiece in mouth, breath in slowly, press canister down and continue to inhale slowly and deeply 4. hold breath for 10s 5. for second dose wait 30s

O SHIT ME! 1. Oxygen 2. Salbutamol nebulisers 3. Hydrocortisone IV or Prednisolone PO 4. Ipratropium bromide nebulisers 5. Theophylline 6. Magnesium sulfate IV 7. ESCALATE

resp Flashcards by Iona Chisholm

criteria for severe asthma

PEFR 33-50% best or predicted
cannot complete sentences
RR >25
HR >110

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criteria for life-threatening asthma

PEFR <33%
SpO2 <92%
silent chest, cyanosis or feeble respiratory effort
dysrhythmia or hypotension
exhaustion, confusion or coma
normal pCO2, if borderline low might need ventilation

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asthma not controlled by SABA + ICS

add LTRA (NICE guidance)

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asthma not controlled by SABA + ICS + LTRA

add LABA

can cont LTRA depending on response

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infective exacerbation of COPD ABX

amoxicillin or clarithromycin or doxycycline
avoid amoxicillin if penicillin allergic
avoid clarithromycin in long QT

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differentiating between transudate and exudate pleural effusion

exudate: protein >30 and LDH >200, pleural effusion fluid protein:serum protein is >0.5
transudate: protein <30

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causes of transudate pleural effusion

heart failure (most common)
hypoalbuminaemia (which can be due to nephrotic syndrome)
hypothyroidism

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causes of exudate pleural effusion

pneumonia (most common)
connective tissue disease: RA, SLE
neoplasia
PE

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causative organism of atypical pneumonia in bird owners

Chlamydia psittaci (psittacosis)

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smoking cessation treatment for pregnant women

nicotine replacement therapy

bupropion is CI

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restrictive spirometry

FEV1:FVC >70%
decreased FVC
normal/decreased FEV1

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inhaler technique

remove cap and shake
breath out
put mouthpiece in mouth, breath in slowly, press canister down and continue to inhale slowly and deeply
hold breath for 10s
for second dose wait 30s

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causes of upper lobe fibrosis

CHARTS

Coal workers pneumoniconiosis
Hypersensitivity pneumonitis (aka extrinsic allergic alveolitis)
Ankylosing spondylitis
Radiation
TB
Sarcoidosis

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causes of lower lobe fibrosis

RASIO

Rheumatoid
Asbestos
Scleroderma
Idiopathic pulmonary fibrosis - most common
Other - AMIODARONE

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COPD not controlled by SABA, no asthmatic features/features suggesting steroid responsiveness

add LABA (Formoterol) + LAMA (Tiotropium)
if already taking SAMA (e.g. Ipratropium) stop this and switch to SABA

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when do you aspirate a pneumothorax

if primary and >2cm rim of air or SoB

if secondary and 1-2cm rim of air

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when do you insert a chest drain for pneumothorax

if primary and aspiration fails

if secondary, >50 years and rim of air >2cm or if aspiration fails

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COPD still breathless despite SABA/SAMA + LABA + ICS

add LAMA

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when should non-invasive ventilation be used in COPD

respiratory acidosis (pH 7.25-7.35 and pCO2 >6kPa) that persists despite best medical mx

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mx of acute asthma

O SHIT ME!

Oxygen
Salbutamol nebulisers
Hydrocortisone IV or Prednisolone PO
Ipratropium bromide nebulisers
Theophylline
Magnesium sulfate IV
ESCALATE

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obstructive spirometry

decreased FEV1:FVC
decreased FVC
significantly decreased FEV1

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mx of allergic bronchopulmonary aspergillosis

prednisolone

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ix for suspected lung cancer

CXR
contrast-enhanced CT
ultrasound guided biopsy

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mx for alpha1-antitrypsin deficiency

no smoking
supportive: bronchodilators, physio
IV alpha1-antitrypsin protein concentrates
surgery: lung volume reduction surgery

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ix for mesothelioma

thoracoscopy and histology

CURB-65 score

``` Confusion Urea >7 mmol/l RR >=30/min BP: SBP <=90; DBP <=60 65 years or older ```

idiopathic pulmonary fibrosis pulmonary function test results

increased FEV/FVC1 | decreased TLCO

ix for sleep apnoea

sleep studies - polysomnography

paraneoplastic syndrome associated with squamous cell lung cancer

increased parathyroid hormone-related hormone hypercalcaemia 'squamous squishes your bones'

paraneoplastic syndrome associated with small cell lung cancer

``` SCLC: SIADH Cushing's (increased ACTH and ADH) Lambert-Eaton myasthenic syndrome (proximal muscle weakness) Cerebellar syndrome ```

COPD still breathness despite SABA/SAMA and asthma/steroid responsive features

LABA + ICS

how to diagnose occupational asthma

PEFR at work and away

CI to lung cancer surgery

SVC obstruction FEV <1.5 malignant pleural effusion vocal cord paralysis

respiratory causes of finger clubbing | A-F

``` Abscess Bronchiectasis Cancer DO NOT SAY COPD Empyema Fibrosis ```

causes of bilateral hilar lymphadenopathy

sarcoid | TB

ix for idiopathic pulmonary fibrosis

high-res CT

empyema aspirate findings

turbid effusion **pH <7.2** low glucose high LDH

diagnostic criteria for ARDS

acute onset pulmonary oedema non-cardiogenic (if pulmonary capillary wedge pressure >15 mmHg consider cardiac pulmonary oedema) pO2/FiO2 <40 kpa (200 mmHg)

indications for starting corticosteroids in sarcoidosis | PUNCH

``` Parenchymal lung disease Uveitis Neuro involvement Cardiac involvement Hypercalcaemia ```

paraneoplastic syndrome associated with adenocarcinoma of the lung

gynaecomastia

causes of lung white out on CXR - trachea pulled towards

pneumonectomy complete lung collapse pulmonary hypoplasia

causes of lung white out on CXR - trachea central

consolidation pulmonary oedema mesothelioma

causes of lung white out on CXR - trachea pushed away

pleural effusion diaphragmatic hernia large thoracic mass

what tests must be done prior to starting Azithromycin

ECG (to exclude QT prolongation) | LFTs

when can long-term oxygen therapy be offered in COPD

pO2 <7.3 kPa OR pO2 7.3-8 and one of: secondary polycythaemia, peripheral oedema, pulmonary hypertension

mx for massive PE + hypotension

thrombolyse with Alteplase | embolectomy is last resort if thrombolysis fails/is CI

Ipratropium

SAMA

Formoterol

LABA

Salmeterol

LABA

Tiotropium

LAMA

sleep apnoea can cause which deranged observation

hypertension

which non-invasive ventilation is used in an acute exacerbation of COPD resistant to best medical mx

BiPAP

risk factors for invasive aspergillosis

immunocompromised patients - HIV, leukaemia | following broad-spectrum ABX

borders of safe triangle for chest drain insertion

lat dorsi pec major line superior to nipple apex of axilla

what does a very high bicarbonate on ABG suggest

chronic respiratory acidosis

vaccinations received in COPD

annual influenza | once-off pneumococcal

features of Addisonian crisis

hyponatraemia hyperkalaemia hypoglycaemia

multiple nodules seen on CXR, most likely dx

metastatic cancer

risk factors for pneumothorax

pre-existing lung disease: COPD, asthma, CF Marfan's, RA non-invasive ventilation

salbutamol

SABA (beta-2 agonist)

extra-pulmonary features of cystic fibrosis

male infertility, female subfertility diabetes mellitus rectal prolapse nasal polyps

whiteout of a lung following aspiration (i.e. choking aspiration not aspiration for pneumothorax)

atelectasis secondary to bronchial obstruction

most likely cause of unilateral pleural effusion

local problem such as bronchial carcinoma

pleural plaques found on CXR mx

they are not malignant so reassurance with no follow up

features of myasthenia crisis

acute respiratory failure characterised by FVC <1 litre use of accessory muscles weak cough

risk factors for aspergilloma

existing lung cavities, e.g. secondary to TB, lung cancer or cystic fibrosis

features of aspergilloma

may be asymptomatic | may present with non-productive cough, haemoptysis

non-smoker - lung cancer

adenocarcinoma

factors which improve survival in COPD

smoking cessation long term oxygen therapy lung volume reduction surgery