Respiratory

Question 1

Massive Hematemesis

Answer 1

Defined by volume of blood:

Typically: 100 – 600ml/24 hours for MASSIVE

Question 2

Cardiac cause of massive heamatemesis

Answer 2

1. PE / infract
2. M. Stenosis
3. AVM
4. Ateriobrachial fistula

Question 3

pneumothorax finding on chest x-ray

Answer 3

White visceral pleural line
No pulmonary vessels visible peripherally
absence of lung vessels lower lobes

Question 4

gaol when treating pneumothorax

Answer 4

1. remove air from pleural space

2. prevent recurrence

Question 5

Contra-indications to chest drain insertion

Answer 5

Bleeding disorder
INR > 1.5
Platelets < 50 x 109, or dysfunctional (uraemia, anti-platelet agents)
Patient on anti-coagulation (DOAC’s / Warfarin)
Diagnosis is uncertain
Lung adherent to chest wall

Question 6

Complication at insertion of chest drain

Answer 6

At insertion
Pain
Infection
Neurovascular bundle damage
Haemorrhage (Perforation of aorta / pulmonary vessel)
Subcutaneous emphysema
Lack of resolution / Failure of procedure
Re-expansion pulmonary oedema
Organ injury/perforation (liver / spleen)
Vaso-vagal reaction
Death

Question 7

S And S life threatening

Answer 7

SYMPTOMS 
Decreasing level of consciousness 
Difficulty completing sentences
Severe dyspnoea
No symptomatic relief following immediate trial of frequent inhaled beta-2-agonist

SIGNS 
Looks distressed
Looks exhausted
Cyanotic
Silent Chest
Bradycardia
Hypotensive
Confused
Comatose

Question 8

SS severe asthma

Answer 8

Symptoms:
Unable to complete sentences

Only partial relief to immediate trial of frequent inhaled beta-2-agonist

Previously symptoms last > 3 days after treatment initiated

Sign:
Resp rate > 25 bpm
HR > 110 bpm
BP = within normal limits

PEFR
< 33-60% of Predicted or Best

Question 9

Moderate asthma

Answer 9

Symptoms: Increasing symptoms
No features of acute severe asthma

PEFR
> 50-70% predicted or best

Question 10

If no responds to normal tx of acute asthma

Answer 10

If not responding consider:
ICU review: ventilator support
IV Magnesium
IV beta-agonist, aminophylline

Question 11

Signs of severity in asthma

Answer 11

Other signs to examine for: 
Pluses Paradoxus
Use of Accessory Muscles
 Diaphoresis
 Inability to lie supine, tachycardia

Question 12

Risk factors for acute asthma

Answer 12

Previous severe exacerbation (e.g. ICU admission/mechanical ventilation required)
>2 hospitalizations for asthma in the last year
>3 A&E visits for asthma in the last year
Hospitalisation/A&E visit for asthma within the last month
Use of more than two canisters of short-acting beta agonist per month
Difficulty perceiving asthma symptoms/severity
Difficult social circumstances/lack of access to primary care
Co-morbidities: cardiovascular, chronic lung, or psychiatric disease