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Flashcards in Respiratory Deck (103)
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1

define ARDS

An acute inflammatory process occurring in the lungs which leads to increased pulmonary vascular permeability and a build up of fluid in the alveoli reducing aerated lung tissue

causes impaired gas exchange and hypoxaemic respiratory failure

2

What are the causes of Ards (8)

Aspiration of gastric or bowel contents into lungs
Chemical inhalation
Lung transplant
Infections e.g. pneumonia from any cause
Severe trauma (i.e. bilateral lung confusion, fat embolism)
Septic shock
Burns
Massive transfusion
Drugs (overdose) and alcohol
Must exclude cardiac cause (not ARDS if caused by cardiac failure)

3

What are the causes of Ards (8)

Aspiration of gastric or bowel contents into lungs
Chemical inhalation
Lung transplant
Infections e.g. pneumonia from any cause
Severe trauma (i.e. bilateral lung confusion, fat embolism)
Septic shock
Burns
Massive transfusion
Drugs (overdose) and alcohol
Must exclude cardiac cause (not ARDS if caused by cardiac failure)

4

ARDS complication <7>

Secondary pulmonary fibrosis (may be irreversible)
Pneuomothorax due to lung stiffness and reduced compliance (Barotrauma from PEEP of ~ > 35mmH2O)
Abnormal lung function
obstruction / restriction / reduced diffusing capacity
Infection
Venous thromboembolism – Pulmonary embolism
Cognitive dysfunction / memory loss as a result of prolonged hypoxaemia and sedation related to ICU stay
Death

5

what are you most likely to die from with ARDS

usually older in age, multiple medical comorbidities, concomitant hepatic failure, history of alcoholism

6

define asthma



Chronic inflammatory disease of the airways associated with reversible airflow limitation and characterised clinically by recurrent respiratory symptoms of dyspnoea, wheezing, chest tightness and/or cough

7

Ddx asthma (10)

COPD
Acute Bronchitis
Bronchiectasis
Inhaled foreign body
Lung cancer/endobronchial tumour
Vocal cord dysfunction (inspiratory stridor)
Gastro-oesophageal reflux
Left ventricular failure
Pulmonary embolism
Pulmonary eosinophilia

8

therapeutic investigation for asthma

Flexible Bronchoscopy – Washings for mucus plugging.

9

Gina guidelines

Variability
is a difference of >20% between morning and evening PEF with bronchodilator usage

Reversibility
is reflected by an increase in PEF >15% after inhalation of a fast-acting ß2-agonist

In patients without bronchodilator use, a variability of >10% meets the definition of asthma

10

obstructive pattern on spirometry

= FEV1/FVC < 70%

11

what is reversibility on spirometry

Reversibility = an FEV1 must increase by > 12%
or > 200 mls

12

Broncoprovaction test


The provocative concentration is the amount of inhaled agonist required to drop the FEV1 by 20% from the baseline

The amount of metacholine required to do this in asthma is usually < 8 mg/min

13

complication of asthma

Status asthmaticus
Pneumothorax
Respiratory failure
Pneumomediastinum
Subcutaneous emphysema
Theophylline toxicity
Hypoxic brain injury
Complications 20 steroid therapy
Mortality with life-threatening asthma

14

COPD definition

COPD is a preventable and treatable disease characterised by airflow obstruction that is not fully reversible

The airflow limitation is usually progressive and is associated with an enhanced inflammatory response of the lungs to noxious particles/gases, primarily tobacco smoke

Heterogenous disease
Chronic Bronchitis
Emphysema

15

Signs of CO2 retention

CO2 rentension
- dilated veins and warm periphery
- astarexis
- bounding pulse
- papilledema
- chemosis
- decrease LOC
- palmar erythemosis (weak finding)

16

Egg findings suggestive of Cor pulmonate

ECG (Suggestive of Cor pulmonale)
Tall P wave, RBBB, Right ventricular hypertrophy

17

in COPD what does the 6 minute walking test tell you


6 minute walk test
≤ 86% = indication for portable oxygen

18

when do you use NIV in acute exhasterbation of COPD

) if arterial pH < 7.35 and/or pCO2 > 6.5 kPa
fac

19

when is long term O2 therapy used


paO2 ≤ 7.3 kPa

paO2 < 8kPa with

- pulmonary hypertension (clinical signs of cor pulmonale/right heart failure) or
- echocardiogram showing a mean Pulmonary Artery Pressure (mPAP) > 20 mmHg

20

Surgery for COPD

Bullectomy

Lung Volume Reduction Surgery (LVRS)
Resection of the most severely affected areas of emphysematous lung
More beneficial in upper lobe emphysema

Lung transplantation

21

complication of COPD (11)

Acute exacerbations COPD
Hypoxia
Hypercapnia
Compensated Chronic Type II Hypercapnic Respiratory Failure
Acute acidotic hypercapnic respiratory failure
Pneumothorax 20 bullous rupture
Recurrent pneumonia
Cor pulmonale
Secondary Polycythaemia
Osteoporosis and diabetes 20 steroid therapy
Hearing impairment from azithromycin prophylaxis

22

Prognosis for COPD

uses the BODE score
1. BMI
2. Obstruction
3. Dyspnea
4. Exercise capacity

Approximate 4-year survival
0-2 points = 80%
3-4 points = 67%
5-6 points = 57%
7-10 points = 18%

23

DDX of cOPD

ABAC
Asthma
Bronchiectasis
A1AT v
CCF

TB
Obliterated bronchiolitis

24

Ddx for CF

Non-CF Bronchiectasis

Common Variable Immunodeficiency (CVID)

Primary Ciliary Dyskinesia (Kartagener’s Syndrome)

Right middle lobe syndrome

Swyer-James Syndrome

Shwachman-Diamond Syndrome

25

Acute management of CF

Antimicrobial therapy tailored to known pathogens and sensitivies

Nebulised bronchodilators

Chest physiotherapy

Mucolytics; DNase (dornase-alpha)

Nutritional support

26

treatment for p. aeruginosa

1. CIPROFLOXACIN PO _ ist isolate

2. exacerbation - treatment with B-lactam and amino glycoside

27

Burkholderia Cepacia complex

1 . ceftazidime
2. pip/tazo

28

Treatment of Macronodular Cirrhosis in CF


Ursodeoxycholic acid, taurine, seek specialist advice
Severe cases may need liver transplant

29

How do you treat complication CF arthropathy


NSAIDs, prednisolone +/- rheumatologist
st

30

drugs targeted to specific mutation

Ataluren - class 1 mutation
Lumacaftor - class 2 - delta508
ivacaftor - class 3 - GG51D mutation