Respiratory Flashcards
(21 cards)
Definition of Asthma
Chronic inflammatory condition of the airways with 3 main features:
- Reversible airflow obstruction
- Airway hypersensitivity
- Inflammation of bronchi
Step 3 Asthma
Moderate Asthma: Daily symptoms. Daily SABA usage. NT Symptoms >1/wk.
FEV1 60-80%.
PEFR 50-80%.
PEF variability >30%.
PRN SABA, ICS (200-800micro g) or sodium chromoglicate, LABA
Step 6 Asthma
Life threatening asthma: Silent chest, exhaustion, cyanosis, bradycardia and hypoventilation
PEFR <30%
Inform ITU and seniors, 15l of O2 with nebuliser salbutamol back to back. Nebulised ipatropium bromide. IV hydrocortisone. ABG (repeat every two hours). Can only be discharged once stabilised and PEFR is >75 predicted/patients best.
Step 5 Asthma
Severe decompensated/Acute severe: Cannot complete full sentences. PEFR <50%. HR>110. RR>25.
Add oral prednisolone 40mg. Safety net and encourage to go to emergency department if no improvement in 12 hours.
Step 2 Asthma
Mild persistant: >2 symptoms/week, >2 NTS in month
FEV1<80%
PEFR >80%
PERF variabiliyu 20-30%
PRN SABA and ICS (200-800 micrograms) or alternatively sodium cromoglicate - mast cell stabiliser
Step 4 Asthma
Severe Asthma: Daily symtoms, limits physical activity, frequent NTS and exacerbations
FEV1<60
PEFR 50-80%
PEF variation >60%
PRN SABA, ICS or sodium chromoglicate, LABA, increase ICS dose to up to 2000 micrograms, consider LTRA (leukotrine receptor antagonists)
Step 1 Asthma
Mild intermittent: <2 symptoms per week. <2NTS symptoms. Asymptomatic between attacks.
FEV1 >80
PEFR 100%
PEF variation 20%
PRN SABA
Mechanisms of protection agains pathogens/infection in respiratory tract
Coughing
Mucociliary escalator
Macrophages
Common bacteria for pneumonia
Streptococcus pneumoniae
Haemophilus influenzae
Staphylococcus Aureus
Rarer:
Mycoplasma pneumoniae
Chlamydia pneumoniae
Legionella pneumophilla
Common pathogen for HAP
MRSA (methicillin resistance staphylococcus aureus)
Also ventilator pneumonia - biofilm
Also aspiration pneumonia during surgery
Lobar pneumonia pathogen
Streptococcus pneumoniae
Pneumonia clinical findings
Fever, dyspnoea, productive cough Dullness to percussion Increased vocal resonance Bronchial breathing coarse crepitations
CXR consolidation
Antibiotics for pneumonia
Mild CAP - Amoxicillin for 5 days
Moderate/severe CAP - Amoxicillin 7-10 days
or if more serious clarithromycin (macrolide) or doxycycline (tetracycline)
Antibiotics for CAP pneumonia
Mild CAP - Amoxicillin for 5 days
Moderate/severe CAP - Amoxicillin 7-10 days
Macrolide such as clarytromycin if allergic. Flucloxacillin in S. aureus
Cavitating lesions on CXR are indicative of which organisms?
TB (mycobacterium tuberculosis or bovine) Staphylococcus aureus Psuedomonas Legionella Fungi
Fungi that causes pneumonia in immunocompromised individuals?
Pneumocysitis jiroverci
CURB65
C - Confusion
U - Urea >7
R - Resp rate >30
B - BP <90 or diastolic BP <60
Age >65
Each gets point, 0/1 <3% mortality in thirty days
2 - 6%
3 - 15%
4, 5 - 30% mortality
Tests for pneumonia
Bedside - RR and BP for calculating CURB65
Lab - Urea (>7 is a CURB65 point), CRP, FBC (neutrophilia), Blood cultures, sputum culture, urine test for legionella and streptococcus antigen
Other - Bronchoscopy for LRT secretion samples
Antibiotic for atypical pneumonia
Erythromycin or clarithromycin
Tetracycline such as doxyclycin for chlamydia or mycoplasma
Antibiotics for HAP
Coamoxiclav with gram -ve cover (ciprofloxacin)
MRSA - vancomycin
Antibiotics for aspiration pneumonia
Cover for anaerobic organisms (from gut such as E coli)
Cephlasporin and metronidazole
Or just coamoxiclav
