Respiratory Flashcards
(35 cards)
What are some clinical features on exam for COPD?
- Hyperinflated chest, reduced chest expansion
- Increased resonance on percussion
- Decreased breath sounds with end exp wheeze
- Signs of RV failure in end stage
What Ix do you see in COPD?
FBE - Polycythaemia
ABG - hypoxaemia, hypercapnia
CXR - hyper expanded lungs, bullae
RFTs- Decreased FEV1/FVC ratio, normal/increased TLC, Decreased DLCO
ECG - Right heart strain, RVH, P pulmonale (large P wave in V1)
What criteria is used to assess severity of COPD?
GOLD
A, B E = Symptoms (CAT or mMRC) + Exacerbation history (>2 moderate or 1 hospital admission = E)
Stages (all have FEV1/FVC <0.7)
1 = mild, FEV1 >80%
2 = moderate, FEV1 = 50-80%
3 = Severe, FEV1 = 30 - 50%
4 = very severe, FEV1 <30%
What is the medical mx of COPD?
- Smoking cessation
- Bronchodilators (b2, anticholinergics)
- Inhaled + systemic corticosteroids
- Vaccinations
- Oxygen therapy (aiming PaO2 60-80mmHg)
What is the surgical options for Mx of COPD?
- Bullectomy
- Lung volume reduction surgery (no survival benefit)
- Lung Tx
- Endobronchial valves
What are the anaesthetic goals in COPD?
-Optomise resp function preop
- Pro-expiratory ventilation and monitoring for gas trapping
- Optomisition for extubation
What are the diagnostic criteria for RVH on ECG?
- RAD
- QRS <0.12secs
- Dominant R wave in V1 >7mm
What is bronchiectasis?
Chronic suppurative disease of the airways that can cause expiratory airflow obstruction
What are the causes of bronchiectasis?
o Congenital – cystic fibrosis
o Acquired – lung infections, localised airway obstruction, inflammation
What are clinical features on history of bronchiectasis?
- Fever
- Cachexia
- Clubbing
- Sputum
- Pan inspiratory crackles over affected lobe
- Signs of right heart failure
What is kartagener syndrome?
inherited ciliary dyskinesia = triad of bronchiectasis, sinusitis + situs inversus
What are the Ix findings in bronchiectasis?
FBC - anaemia of chronic disease, leukocytosis
CXR - hyperinflation, collapse in segments
PFTs - obstructive pattern followed by mixed pattern as disease progresses
What is the medical mx of bronchiectasis?
- Smoking cessation
- Antibiotics to prevent and treat infections
- Mucolytic agents
- Inhaled bronchodilators
- Vaccinations
What are some anaesthetic goals in bronchiectasis?
- Optomise preop - may need preop antibiotics, steroids or physio
- Intubation required for secretion management if GA
- Can consider DLT if unilateral bronchiectasis
What is asthma?
chronic airway inflammation, reversible expiratory airflow obstruction in response to various stimuli & bronchial hyperreactivity
What some exam findings in asthma?
- Wheeze
- Tachypnoea
- Dry/productive cough
- Prolonged forced expiratory time
- Hyperinflated lungs
What are some Ix findings in asthma?
- ABG - either normal or if asthma attack then decreased CO2 and resp alkalosis
- PFTs - Obstructive pattern with bronchodilator responsiveness
- CXR - hyperinflation
- ECG - tachycardia
How do you classify severity of asthma?
Two ways:
Amount of treatment required for good control:
- Daytime symptoms <2 days/week
- Need for reliverer <2 days/week
- No Limitation of acitivity
- No Symptoms during night or waking
Good control is all of the above
Partial control is 1-2
Poor control is >2
FEV1 % predicted measurements is other way
Mild = 65-80
Moderate = 50-65
Severe = 35-50
Very severe = <35
What are some anaesthetic goals with asthma?
- Aim to suppress bronchospasm:
Avoid histamine releasing drugs
LMA better than ETT
Preop ventolin
Smooth extubation
Use volatile - Pro expiratory ventilation
Long I:E ratio
TV 8mls/kg
RR 6-8
avoid PEEP
Permissive hypercapnia
What are the types of restrictive lung disease?
Acute intrinsic - pulm oedema, ARDS, aspiration
Chronic intrinsic - Sarcoidosis, pulm Fibrosis
Chronic extrinsic - deformities of skeletal system, mediastinal mass, neuromuscular disorders
What are exam findings in restrictive lung disease?
- Chest wall deformity (depending on cause)
- Fine crackles if intersitial lung disease
- Cor pulmonale - RV heave, Loud P2
What are some Ix findings in restrictive lung disease?
FBE - polycythaemia
ABG - hypoxaemia
PFT - decrease in all lung volumes, normal FEV1/FVC
DLCO - decreased in intrinsic disease, normal in extrinsic disease
What scoring system is used in pneumonia?
CURB -65
Confusion
Urea > 7
Resp rate >30
BP <90 sys
Age >65
Score >1 = inpatient treatment
What is apnoea defined as?
cessation of breathing for longer than 10 seconds
