Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Emergency Medicine Assistantship > Respiratory Emergencies > Flashcards

Respiratory Emergencies Flashcards

(66 cards)

Start Studying
1
Q

A patient comes to A+E with a productive cough and severe shortness of breath. What other symptoms and signs might indicate pneumonia?

A 
Fever
Chest pain
Coryzal symptoms
Headaches
Muscle pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What clinical features predict adverse prognosis in acute pneumonia?

A
  • Confusion
  • Urea >7
  • RR >30
  • Hypotension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How should an acute pneumonia be approached initially?

A

ABCDE of course!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What signs might a patient with acute pneumonia have that would indicate possible ITU admission?

A
  • Respiratory failure
  • Acidosis
  • Hypoperfusion
  • Progressive exhaustion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the pathophysiology of pneumonia?

A

Acute infection causing inflammation of alveoli and terminal bronchioles with intense infiltraion of neutrophils.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the common organisms for community acquired pneumonia?

A
  • Strep. pneumoniae
  • Staph. aureus
  • Mycoplasma pneumoniae
  • H. influenzae
  • Chlamydophila pneumoniae
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What signs of pneumonia are often found on examination?

A
  • Tachypnoea
  • Bronchial breathing
  • Crepitations
  • Pleural rub
  • Dullness to percussion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the scoring system admission criteria for pneumonia?

A

CURB-65 score - consider admission if score 2+ points:

  • Confusion
  • Urea over 7mmol/L
  • Resp rate over 30
  • BP under 90 mmHg systolic or 60mmHg diastolic
  • Age 65+
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the essential management points for pneumonia?

A

-Abx
-Oxygen
-Fluids
-Analgesia
Nebulised saline for expectoration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the atypical organisms that cause pneumonia most commonly?

A
  • Mycoplasma pneumoniae
  • C. pneumonia
  • Legionella pneumophila
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How common are atypical organisms in causing pneumonia?

A

May account for around 30% of all CAP.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the difference between severe asthma and status asthmaticus?

A

Status asthmaticus does not respond well to immediate care and is a medical emergency.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

True or false - around 70% of deaths from asthma are thought to be preventable?

A

False - around 90% are thought to be preventable.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How can we tell someone has severe asthma from the history?

A
  • Previous near fatal episodes
  • Previous hospital admissions
  • Use of 3+ types of asthma medication
  • Heavy use of beta 2 agonists
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Is a pt who is asthmatic and sensitive to NSAIDs more or less likely to have severe asthma?

A

More likely.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Is a history of good or poor asthma control more likely in a pt who presents with a severe asthma attack?

A

Poor control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the signs and symptoms of a moderate asthma attack?

A

PEF more than 50-75% of best or predicted

No features of severe asthma but with worsening symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the signs and symptoms of a severe asthma attack?

A
  • PEF 33-50% of best or expected
  • RR 25+
  • HR 110+
  • Unable to complete sentences in one breath
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the signs and symptoms of a life threatening asthma attack?

A
  • PEF 33% or worse of best or expected
  • Sats under 92%
  • PaO2 <8 kPa
  • Normal PaCO2
  • Exhaustion/altered LoC
  • Hypotensive
  • Arrthymias
  • Cyanosis
  • Silent chest
  • Poor respiratory effort
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the general measures for managing an acute asthma attack in an adult?

A

ABCDE, with:

  • High flow oxygen
  • B2 agonist nebulisers
  • Steroids
  • Ipatropium bromide nebuliser
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the target saturations for a pt with an acute asthma attack?

A

94-98%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When can IV Beta 2 agonists be used for acute asthma?

A

In those pts where inhaled therapy is not reliable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When can PEF values be used to determine the severity of an asthma attack?

A

Only if recent best PEFs are available for the last 2 years.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What PaCO2 is most concerning in acute asthma?

A

Raised as it indicates that the respiratory effort is exhausted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are the 2 main factors that contribute to poor outcomes in asthma attacks?
- Failure to recognise severity properly | - Under-use of corticosteroids
26
What dose of inhaled salbutamol is given by nebuliser for any acute asthma?
5mg
27
What dose of inhaled prednisolone is given for moderate asthma?
40-50mg PO
28
What dose of steroids is given for acute severe or life threatening asthma?
Prednisolone 40-50mg PO | Hydrocortisone 100mg IV
29
What dose of ipatropium bromide is given for life-threatening asthma?
0.5 mg
30
What complications can occur secondary to status asthmaticus?
- Aspiration pneumonia - Pneumomediastinum/thorax - Rhabdomyolysis - Respiratory or cardiac arrest - Hypoxic-ischaemic brain injury
31
When might a traumatic pneumothorax occur?
Following penetrating chest trauma e.g. stab wound, gunshot injury, or fractured rib.
32
When might an iatrogenic pneumothorax occur?
- Mechanical ventilation - Central line placement - Lung biopsy - Percutaneous liver biopsy
33
What immediate management should be performed for a tension pneumothorax?
Oxygen and emergency needle decompression.
34
Describe how decompression of a tension pneumothorax should be performed?
With a large-bore needle into the pleural space, MCL 2nd ICS.
35
What are the typical symptoms of a pneumothorax?
-Sudden onset chest pain and shortness of breath
36
What imaging is recommended for confirmation of a pneumothorax?
Erect chest xray - but not for a tension pneumothorax as this should be confirmed by air decompression in initial management.
37
Describe what the chest examination is like for a pneumothorax?
- Reduced air entry on affected side - Trachea deviated away from side of collapse - Hyper-resonance over pneumothorax - Breath sounds reduced
38
How should a tension pneumothorax be managed following initial decompression?
Insertion of chest drain depending on severity
39
Where are chest drains inserted?
4th-5th intercostal space, mid axillary line, over the superior rib margin.
40
Why should a chest drain be inserted just above the rib rather than just below?
To avoid the neurovascular bundles which run along the inferior border of each rib.
41
What are the complications of chest drain insertion?
- Pain - Intrapleural infection - Wound infection - Drain dislodgement - Drain blockage
42
What is a pulmonary embolism?
Thrombo-embolic obstruction of the pulmonary arterial tree causing repsiratory distress and dyspnoea
43
What are the causes of a PE?
- Thrombosis from distant vein - Fat embolus - Amniotic fluid - Air
44
When might a fat embolus causing a PE occur?
Following a long bone fracture or orthopaedic surgery
45
What is the most common cause of PE?
Embolus from DVT.
46
What are the big risk factors for a PE?
Increased blood coagulability Reduced mobility Blood vessel abnormalities
47
Which groupd of people are at risk of a PE due to decreased mobility?
- Surgical patients - Limb injuries/problems - Elderly - Spinal cord injuries - Long distance sedentary travel
48
What are the major risk factors for a PE?
- Surgery - Obstetric patients - Lower limb problems - Malignancy - Reduced mobility - Previous VTE - Major trauma
49
A patient presents with sudden onset SoB and chest pain. What other symtpoms might indicate a PE?
- Pleuritic or retrosternal chest pain - Cough - Haemoptysis - Signs of DVT
50
What is the most common finding on an ECG for a PE?
Sinus tachycardia
51
What are the textbook findings for a PE on ECG?
- Tachycardia - S1Q3T3 pattern - ST depression or signs of ischaemia if large
52
What signs might a patient with a PE have?
- Tachycardia - Tachypnoea - Hypoxia - Pyrexia - Elevated JVP - Shock - Pleural rub - Gallop rhythm
53
If a PE is suspected, do we wait for a diagnosis to treat?
No, give treatment dose LMWH then confirm diagnosis later.
54
What score can we use to assess risk for PE?
Well's score
55
If a patient scores likely for a PE on Well's score, what should be done?
Start LMWH and send for CTPA
56
If a patient has a ?PE but also has renal impairment, what can we do instead of CTPA?
V/Q SPECT scan
57
If a patient has an otherwise unprovoked PE, what blood tests should we do?
Antiphospholipid antibodies
58
What are the points of the Well's score?
- DVT suspected? 3 - Alt diagnosis less liekly? 3 - Tachycardic? 1.5 - Reduced mobility? 1.5 - Hx of DVT/PE? 1.5 - Haemoptysis? 1 - Malignancy? 1
59
At what score on Well's score is a PE likely?
More than 4 points
60
What is the S1Q3T3 pattern on an ECG classically found with a PE?
- Deep S waves in Lead I - Q waves in Lead III - Inverted T waves in Lead III
61
What blood test is done for a PE investigation, and how useful is it?
D-dimer - if it is negative, it is very useful as it is very sensitive, but if it is positive it isn't very helpful as it is not very specific.
62
A patient presents with dyspnoea and a swollen right leg. What specific investigation can we do?
Leg ultrasound | CTPA or V/Q scan
63
What needs to be checked before LMWH is started in a patient with a PE?
Renal function Allergies Bleeding risk assessment
64
How do we assess bleeding risk before starting LMWH?
HAS-BLED score
65
What are the elements of has-bled score?
- HTN >160? 1 - Renal disease? 1 - Liver disease? 1 - Stroke Hx? 1 - Major bleeding or bleeding risk? 1 - Labile INR? 1 - Age over 65? 1 - Drugs predisposing to bleeding? 1 - Alcohol >8 units/wk? 1
66
When should thrombolysis be considered for a PE?
If they are haemodynamically unstable or if anticoagulation cannot be offered.

Emergency Medicine Assistantship (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions