Resp cards Flashcards
(78 cards)
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
CPAP gets fluid out of lungs, and for OBSleep apnoea
BPAP gets co2 out of lungs in retainer
AECOPD?
cx?
admit?
TX in hospital?
no exacerbation cx of pneumonia in COPD?
HIb, Moraxella, strept pneumoniae.
C/S 5 days
only tx if new sputum
admit: 02<90, low GCS, cyanosis,co-morbidity/sob.
tx in hosp:
28% Venturi mask at 4 l/min if RF for hypercapnia 88-92
ipr+saba nebs, CS po pred or IV hydroctorisone
Ic theophylline if no response to bronchodilators
NIV if PH 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 )
when to have stand by meds?
proph: azithromycin, recurrent exacerbation despite not smoking and inhaler control. do HRcT thorax to exclude bronchiectasis and ECG to see QT interval, LFTs
stand by: 1 exacerbation in last yr, know risk and venefit
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? *12+, new guide
new:
low ICS+formoterol as needed
regular low ICS/formoteral MART
regular moderate MART
do FeNo/ eosinophil
Trial LTRA/ LAMA
resp specialist
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 - (reduced TLCO)
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?
mx of acute asthma?
low p02 causing hyperventilation
- Oxygen
- Salbutamol nebs 5mg every 15 mins
- Ipratropium bromide 0.5mg nebs
- PO pred or IV hydrocortisone
- IV Magnesium Sulphate 2g over 20 mins
- CXR
resp alkalosis cx? - things that make you out of breath
S
H
O
R
T
S salycilste poisoning, strkoe, SAH,
High altitude
O (pregnant)
R (woRRY)
Thrombus - pulmonary embolism
obstructive spirometry?
FEV1/FVC <0.7
FEV1 <80% normal
FVC reduced/ normal, not as reduced as fev1
cx: Asthma
COPD - alpha one
Bronchiectasis - clubbing, yellow nail, tram track XR,
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
no flying for 1 week post check XR.
smoking cessation?
2 weeks of NRT therapy, and 3-4 weeks for varenicline (caution suicide, partial N agonist) and
bupropion - does both, noradrenaline reuptake inhibitor and partial nicotine R antagonist (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? - hypo ventilation
inadequate ventilation - COPD/ gbs, opiates, MND, rib fracture, obesity, MG,
What is transudate pleural effusion? (protein <30)
What is indication for chest drain of 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
chest drain - turbid fluid or PH <7.2 suspicious of infection
pleural effusion: what is exudate? light’s criteria?
My ex is over 30 and a bit of a cancer/ infection.
local causes: autoimmune, malignancy, infection, drugs, PE
do light sif protein is 25-30
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 lactic acid/ other acids bind to HCO3- in blood. CX: DKA, lactic acidosis, aspirin OD, ethylyn glycol poisoning, methanol poisoning, renal failure (normal HCO3 loss that kidneys cant keep up with and replace Cl-)
normal anion gap is when HCO3 is lost and replaced by Cl-
Normal anion gap cx? (hyperchloraemic acidosis)
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
