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CP3 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

severe asthma

A

o Unable to complete sentences
o Respiratory rate >25/min
o Pulse rate >110 beats/min
o Peak expiratory flow 33-50% of predicted/best

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2
Q

life threatening asthma

A

o Peak expiratory flow <33% predicted/best
o Silent chest, cyanosis, feeble respiratory effort
o Bradycardia or hypotension
o Exhaustion, confusion or coma
o Increase in pCO2 and this patient is almost dead
WARN ICU

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3
Q

step 1 asthma mx

A

inhaled saba prn

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4
Q

step 2 asthma

A

saba + low dose ics

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5
Q

step 3 asthma

A

saba + ics + laba

if no response to laba, increase ics

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6
Q

step 4 asthma

A

increase ics
consider LTRA/theophylline
or beta 2 agonist tablet

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7
Q

step 5

A

refer

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8
Q

acute asthma

A

nebulised salbutamol +/- ipatropium bromide +O2
iv hydrocortisone
single dose MgSo4 over 20 mins IV

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9
Q

if asthma attack improving

A

nebs 4 hourly

pred 5-7 days after

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10
Q

COPD lifestyle changes

A

stop smoking
pneumococcal and flu jab
regular lung function assessment

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11
Q

Stepwise drugs for COPD

A 
SABA , 
LABA + LAMA (if not asthmatic and no steroid responsiveness)
LABA + ICS (if opposite)
LABA + LAMA + ICS
oral theophylline
mucolytic if chronic productive cough
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12
Q

Acute COPD exacerbation

A 
Increase SABA dose
prednisolone 7-14 days
ABx
IV theophylinne
NIV/Doxapam if unavailable
O2
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13
Q

NIV indication

A

persistant hypercapnic ventilator failure in exacerbations

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14
Q

smoking cessation

A

NRT
varenicline/bupropoin
support programme

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15
Q

Bronchiectasis

A 
Postural drainage - physio
Abx + intermittent chemo
if still not working, probs p.aeurginosa
Bronchodilators
Anti inflammatorys
surgery - rare, transplant
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16
Q

P aeruginosa bronchiectasis

A

parenteral/ nasal chemo
ceftazidime
ciprofloxacin

17
Q

CF - lifestyle

A

MDT
stop smoking
pnemococcal and flu jabs
physio

18
Q

CF medical

A 
O2 prn
Abx same as bronchiectasis
70% have pseudomonas
SABA + ics for relief
hypertonic saline + DNAse inhalation
Mucolytic
NIV 
treat pancreatic insufficency + malnutrition
lung transplant (+/- heart)
19
Q

Pneumonia general

A 
O2
IV fluids
Abx
thromboprophylaxis
physio
nutritional supplements
analgesia
cxr 6 weeks later + smoking cessation
20
Q

low cap

A

amoxcicillin + doxy

21
Q

moderate cap

A

amox and clarithromycin

22
Q

severe cap

A

co amoxiclav

clarithromycin/cefuroxime

23
Q

HAP

A

o Aminoglycoside IV + antipseudomonal penicillin IV or 3rd gen cephalosporin IV
o If on CCU: Tazocin IV 4.5g tds for 7 days or Meropenem IV 1g tds (not naïve) or Vancomycin IV 1g bd (MRSA)

24
Q

TB

A

6 months treatment
2 months Isoniazid + rifampicin, ethambutold, pyrazinamide
4 months Isoniazid + rifampicin

25
Q

CNS TB

A

12 months + corticosteroids (same in pericardial)

26
Q

TB contact tracing

A
  • Household or other close contacts
  • New entrants from high incidence countries
  • Immunocompromised
  • Healthcare workers
  • Done after diagnosis of a new case of TB
  • Aim to seek those who may have been exposed to infection and are not yet treated
27
Q

pneumothorax

A

decompression 2nd ICS MCV if tension

chest drain in med/large simple pneumothoraces

28
Q

lung cancer

A

assess for fitness for treatment
surgery (chemo/radio before to shrink)
radiation for cure/symptoms
chemo in non small cell

29
Q

lung cancer palliation

A

laser therapy
endobrachial irradiation
tracheobronchial stents

30
Q

pleural effusion

A

pleural tap
pleurodesis
surgery

31
Q

fibrosis

A

stop smoking
steroids
Azathioprine or cyclophosphamide added if there’s no response
Pirfenidone, an anti-fibrotic anti-inflammatory drug reduces mortality
Oxygen therapy is used
Lung transplant may be offered in younger patients

32
Q

extrinsic allergic alveolitis

A

remove allergen
O2
oral pred

chronic: prevention
avoid exposure
facemask
long term steroids
compensation
33
Q

OSA

A

correct treatable factors: fat, acromegaly, big tonsils
nasal probs, alcohol/sedatives/antidepressants
CPAP
modafinil

34
Q

T1RF

A

o Treat underlying cause
o Give oxygen (35-60%) by facemask to correct hypoxia
o Assisted ventilation if PaO2 <8kPa despite 60% O2

35
Q

T2RF

A

o Remember the respiratory centre may be relatively insensitive to CO2 and respiration could be driven by hypoxia
o Treat underlying cause
o Controlled oxygen therapy: start at 24% (Note can have up to 15 minutes high flow oxygen, but then must reduce)
o Recheck ABG and if PaCO2 is steady or lower, increase the oxygen concentration to 28%. If PaCO2 has risen >1.5kPa and the patient is still hypoxic consider assisted ventilation (e.g. NIPPV). Rarely use a respiratory stimulant (e.g. doxapram 1.4-4mg/min IVI)
o If this fails consider intubation and ventilation, if appropriate

CP3 (13 decks)

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