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Flashcards in Respiratory Deck (9)
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1

Acute exacerbation COPD

O2 therapy
bronchodilation (salbutamol and ipratropium)
steroids - iv hydrocortison --`. pred po (5d)
abx if infective - Need 2 of:
o Increased breathlessness
o Increased sputum volume
o Increase sputum purulence
o Increased breathlessness

2

COPD

o General
i. Smoking cessation
ii. Annual influenza vaccine + one off pneumococcal vaccine
iii. Home supply of antibiotics and prednisolone if recurrent exacerbations

o Medical therapy escalation:
1. SABA or SAMA
2. Add LAMA, or LABA (with ICS if FEV1 <50%)
3. Take all 3
4. Theophylline
5. Mucolytics

3

Indications for LTOT

- Ankle oedema
- Two ABGs with pO2 < 7.3
- FEV1 <30%
- Cyanosis
- Polycythaemia
- Raised JVP
- Sats of less than or equal to 92% room air

4

COPD diagnosis

FEV1/FVC < 70% + symptoms suggestive of COPD

5

pneumonia

o CURB65 score (confusion, urea >7, RR>30, BP<90/60, >65)
o 0-1 = home care (<3% mortality) à amoxicillin 5 days
o 2-3 = hospital care (3-15% mortality) à amoxicillin + clarithromycin 7 days
o 3+ = ITU (15%+ mortality) à consider co-amox or Tazocin

6

lung cancer - surgery CI

o SVC obstruction
o FEV < 1.5L
o Malignant pleural effusion
o Vocal cord paralysis
o Stage IIIb or IV OR tumour near hilum

7

acute asthma

1. Oxygen to 94-98%
2. Salbutamol nebuliser back to back driven by oxygen
3. Ipratropium nebulise once
4. Prednisolone for at least 5 days
5. Magnesium sulphate 1.2-2g over 20 mins
6. IV salbutamol

8

bipap

- COPD with acidosis of 7.25-7.35
- Type II respiratory failure
- Cardiogenic pulmonary oedema unresponsive to CPAP
- Weaning from tracheal intubation

9

pe/dvt

Treating:
o If hypotensive (sbp<90) à massive PE à Heparin whilst you wait for thrombolysis = alteplase
o If stable:

i. LMWH for 5 days or until INR >2 (whichever is longer) – if active cancer LMWH is kept for full 6 months

ii. Warfarin started within 24 hours and for:
a. 3 months if PE was provoked (surgery, trauma, immobility)
b. 6 months if unprovoked