Resp cards Flashcards
CPAP works by?
increasing intrathoracic pressure, which decreases diastolic and systolic transmural pressures. This can reduce LV preload and afterload, which can decrease cardiac output in most situations. good for T1RF, keep alveoli open and reduce WOB
AECOPD?
cx?
admit?
TX in hospital?
HIb, Moraxella, strept pneumoniae. only tx if pneumonia/ purulent sputum. oherwise C/S 5 days reduces frequency of exacerbations.
admit: 02<90, low GCS, cyanosis,co-morbidities/sob.
tx in hosp:
28% Venturi mask at 4 l/min if RF for hypercapnia 88-92
ipr+saba nebs, CS
NIV 7.25 -7.35, HDU. Bipap
MX COPD? chronic?
C/S responsive features?
if features of HF?
- SABA/SAMA
- features of Cs responsivenmess -
- no features - SABA+LABA+LAMA
- if features - SABA/SAMA PRN+LABA+ICS
vaccines: pneumococcal one off, annual flu
CS response features? asthma/ atopy/ eosinophils/ 400ml variation in fev1, 20% diurnal variation in PEFR
cor pulmonale - loop diuretics.
who is abx prophylaxis for?
(COPD )
proph: azithromycin, recurrent exacerbations despite no smoking and inhaler control. do cT thorax to exclude bronchiectasis and ECG to see QT interval, LFTs
COPD MX - when to consider theophylline?
trialled inhaled therapy but not working.
reduce dose if macrolide or fluoroquinolone abx are co-prescribed
when to suspect COPD?
IX?
CXR? whats on FBC
stages?
35+ smoke/ ex smoker/ SOB/ cough pururlent
IX: FEV1/FVC <0.7 post bronchodilator,
CXR:
hyperinflation, bullae, flat hemidiaphragm, polycythaemia fbc.
stages: 1=80%+ predicted FEv1 (Sx= dx)
2 = 50=57 mod
3 = 30-49 severe
4 <30% very severe
pneumonia: alcoholic and diabetics
may occur following aspiration
‘red-currant jelly’ sputum
often affects upper lobes
klibsiella
Asthma chronic mx?
- SABA
- SABA + low ICS
- +mTrial LTRA
- SABA + low ICS + LABA +/- LTRA
- SABA+ MART +/- LTRA
- Mod MART / switch to mod ICS +LABA as above
- high ics + LABA stop MART
- trial theophylline. LAMA/ expert
50YO progressive exertional dyspnoea, clubbing, cough, bibasal crackle
FEV1:FVC >70%, decreased FVC
impaired gas exchange (reduced TLCO - transfer factor for carbon monoxide)
Restrictive pic
pulmonary fibrosis
other restrictive cx:
Asbestosis
Sarcoidosis
Acute respiratory distress syndrome
Infant respiratory distress syndrome
Kyphoscoliosis e.g. ankylosing spondylitis
Neuromuscular disorders
Severe obesity
why do you get low Pc02 in asthma?
low p02 causing hyperventilation
resp alkalosis cx?
anxiety leading to hyperventilation
pulmonary embolism
salicylate poisoning*
CNS disorders: stroke, subarachnoid haemorrhage, encephalitis
altitude
pregnancy
obstructive spirometry?
FEV1/FVC <0.7
FEV1 <80% normal
FVC reduced/ normal, not as reduced as fev1
cx: Asthma
COPD
Bronchiectasis
Bronchiolitis obliterans
CF
Restrictive spirometry pattern?
fev1< 80% of rpedicted
FVC < 80% predicted normal
fev1/fvc ratio = >0.7
CX:
PF
pulmonary oedema
lobectomy/ pnuemectomy
paranchymal lung disease
kyphoscoliosis
connective tissue diseaseobesity/ pregnancy
what is bode index?
mortality in COPD indicator - fev1, BMI, 6 min walk, sob
When to insert chest drain for pneumothorax?
sX+ high risk - lung disease, 50+/smoking, hb unstable, haemothorax, B/L,hypoxia.
if sx and not high risk - ambulatory device - fu 2 daily/ needle aspiration/ chest drain with F/U in 2-4 weeks
no sx - F/U 2-3 daily
smoking cessation?
2 weeks of NRT therapy, and 3-4 weeks for varenicline (caution suicide) and bupropion (CI epilepsy, pregnancy).
don’t re-px within 6 months
abg of co2 retainer?
ABG triad for chronic CO2 retention:
Normal pH
High pCO2
High HCO3
48 hrs after post trans thoracic/ abdo surgery, mild pyrexia, reduced breath sounds and tachypnoeia?
Basal atelectasis. within 48 hrs. cx: mucus in bronchiole tree retained, bronchioles are blocked and air is re-absorbed, asal collapse. these may become infected
Resp acidosis cx?
inadequate ventilation - COPD/ gbs, opiates, MND, rib fracture, obesity.
What is transudate pleural effusion?
Fluid pushes through capillary due to capilalary hydrostatric pressure increase or decreased oncotic pressurefrom systemic causes - HF, cirrhosis, peritoneal dialysis, hypoalbuminaemia
less common: nephrotic syndrome, PE, MS, hypothyroid
pleural effusion: what is exudate? light’s criteria?
local causes: autoimmune, malignancy, infection, drugs, PE
fluid: serum LDH >0.6
fluid: serum protein >0.5
fluid LDH > 2/3upper limit of normal serum LDH
When to calculate anion gap in ABG? (NA-cl-hco3).
Cx of high?
split causes of metabolic acidosis further. high anion gap means reduced renal excretion of H+ or production
CX: DKA, lactic acisodid, aspirin OD renal failure
normal anion gap is when HCO3 is lost and replaced by Cl-
Normal anion gap cx?
RTA, addisions, GI H+ losses (ileostomy, colostomy, D+V)
pneuomnia cx of 20 yo uni student with bullous myringitis. cxr has more infiltrates than physically heard?
mycoplasma pneumoniae
late onset HAP cx? 5 dya s+
MSRA, pseudomonas (green coloured sputum), gram negative: klibsiella/ ecoli
obrustive cleep apnoea sclaes?
epworth sleepiness scale
stop/bang questionnaire
2ww criteria resp cancers?
40+ with unexplained haemoptosis/ changes on CXr suspicious.
offer CXr in 2 weeks for 40+ and 2 + points or if smoked and 1+ points:
cough/ fatigue/ chest pain, WL, appetite
consider CXR in 40+ and thrombocytosis/LN/ finger clubbing/persistent/ recurrent illness
most common cap cx with rust coloured sputum?
other common cap with green sputum?
strep pnuemoniae
other: Haemophilus influenzae - common cap, green sputum/ q will say they ahve pneumoccocal vaccine
When Pleural effusion is aspirated what is the most common finding?
what is generally the most common cause?
malignancy
cx common: HF
CXR: multiple B/L noduels different sizes through lung fields. 50YO miner and RA?
Caplan’s syndrome/ pulmonary fibrosis in miners/ RA