Respiratory Emergencies

Question 1

What sort of individual experiences anaphylaxis?

Answer 1

Sensitised individual is exposed to a specific antigen

Question 2

What sorts of things commonly cause anaphylaxis?

Answer 2

Insect bites/stings, food, medications

Question 3

What is the immunological response in anaphylaxis?

Answer 3

IgE -> Antigen -> Mast cell and basophils -> Increased histamine -> Body response

Question 4

Over what period of time does anaphylaxis occur?

Answer 4

Minuted

Question 5

Symptoms and signs of anaphylaxis

Answer 5

Pruritis, urticaria, angioedema, hoarseness, progressing to stridor and bronchial obstruction, wheeze and chest tightness due to bronchospasm

Question 6

Treatment of anaphylaxis

Answer 6

Remove trigger, maintain airway, 100% oxygen
IM adrenaline 0.5mg repeated every 5 min as needed
IV hydrocortisone 200mg
IV chlorpheniramine 10mg
Bronchospasm -> NEB salbutamol
Laryngeal oedema -> NEB adrenaline

Question 7

In anaphylaxis, what dose of adrenaline should be given?

Answer 7

0.5mg

Repeat every 5 min

Question 8

In anaphylaxis, what does of hydrocortisone should be given?

Answer 8

200mg

Question 9

In anaphylaxis, what dose of chlorpheniramine should be given?

Answer 9

10mg

Question 10

Define MILD asthma

Answer 10

No features of severe asthma

PEFR >75%

Question 11

Define MODERATE asthma

Answer 11

No features of severe asthma

PEFR 50-75%

Question 12

Define SEVERE asthma

Answer 12

PEFR 33-50%
Cannot complete sentences in one breath
Respiratory rate >25/min
HR >110bpm

Question 13

Define LIFE THREATENING asthma

Answer 13

PEFR <33%
Sats <92@ or ABG pO2 <8kPa
Cyanosis, poor respiratory effort, near or fully silent chest
Exhaustion, confusion, hypotension or arrhythmias
Normal pCO2

Question 14

Define NEAR FATAL asthma

Answer 14

Raised pCO2

Question 15

What is the management for acute asthma?

Answer 15

ABCDE 
Aim for SpO2 94-98%
ABG if sats <92%
5mg nebulised salbutamol (can repeat after 15min) 
40mg oral prednisolone STAT 
(IV hydrocortisone if PO not possible)

Question 16

What is the management for severe asthma?

Answer 16

Nebulised ipratropium bromide 500 micrograms

Consider back to back salbutamol

Question 17

What is the management for life threatening/near fatal asthma?

Answer 17

Urgent ITU assessment
Urgent portable CXR
IV aminophylline
Consider IV salbutamol if nebulised route ineffective

Question 18

What are the 2 types of COPD exacerbation?

Answer 18

Infective

Non-infective

Question 19

What things could indicate an infective COPD exacerbation?

Answer 19

Change in sputum volume/colour
Fever
Raised WCC +/- CRP

Question 20

How should a COPD exacerbation be managed?

Answer 20

Oxygen 
NEBs - salbutamol and ipratropium 
Steroids - prednisolone 30mg STAT, OD 7 days 
Antibiotics if indicated 
CXR 
Consider IV aminophylline 
Consider NIV if type 2 resp failure and low pH 
ITU referral if pH <7.25

Question 21

How should oxygen therapy be delivered in an exacerbation of COPD?

Answer 21

Via a fixed performance face mask due to risk of CO2 retention
Aim for sats of 88-92% guided by ABG

Question 22

How can pneumonia be diagnosed?

Answer 22

Consolidation on CXR with fever

+/- purulent sputum +/- raised WCC/CRP

Question 23

What tool can be used to identify pneumonia?

Answer 23

CURB-65

Question 24

What is CURB-65?

Answer 24

Confusion (MMT 2 or more)
Urea >7 
RR >30/min
BP <90mmHg systolic or <60mmHg diastolic 
65

Question 25

What is the definition of massive haemoptysis?

Answer 25

>240mls in 24hrs | or >100 mls/day over consecutive days

Question 26

What is the management of massive haemoptysis?

Answer 26

``` ABCDE Lie patient on side of suspected lesion Oral tranexamic acid 5 days IV Stop NSAIDs/aspirin/anticoag Antibiotics if infection Consider Vit K CT aortagram ```

Question 27

What features may be present in a patient with a tension pneumothorax?

Answer 27

Hypotension Tachycardia Deviation of trachea away from side of pneumothorax Mediastinal shift away from pneumothorax

Question 28

What is the management of a tension pneumothorax?

Answer 28

Large bore cannula into 2nd ICS MCL | Then chest drain to affected side

Question 29

What are some symptoms of PE?

Answer 29

SOB Pleuritic chest pain Haemoptysis Low CO then collapse

Question 30

Name some major risk factors for PE

Answer 30

Surgery: abdo/pelvic, knee/hip replacement, ITU admission Obstetric: Late pregnancy, caesarian section Lower limb: fracture, varicose veins Malignancy: abdo/pelvic/metastatic Reduced mobility Previous proven VTE

Question 31

What is the management of PE?

Answer 31

``` ABCDE Oxygen if hypoxic Fluid resuscitation Thrombolysis if massive PE - confirm on ECHO or CT Anticoag ```

Question 32

What may you see on CT/ECHO in a patient with a massive PE?

Answer 32

Right heart strain

Question 33

How can thrombolysis contraindications be grouped?

Answer 33

Absolute | Relative

Question 34

What are some absolute contraindications to thrombolysis?

Answer 34

``` Haemorrhagic or ischaemic stroke <6months CNS neoplasia Recent trauma or surgery GI bleed <1 month Bleeding disorder Aortic dissection ```

Question 35

What are some relative contraindications to thrombolysis?

Answer 35

Warfarin Advanced liver disease Infective endocarditis Pregnancy

Question 36

What are some complications of thrombolysis?

Answer 36

``` Bleeding Hypotension Intracranial haemorrhage/stroke Allergic reaction Systemic embolisation of thrombus Reperfusion arrhythmias ```