What is anaphylaxis and angioedema?
A serious allergic reaction in a sensitisted individual when exposed to a specific antigen
What are some of the clinical signs and symptoms of anaphylaxis and angioedema?
- Pruritis
- Urticaria
- Angioedema
- Hoarse voice
- Progressing stridor and bronchial obstruction
- Wheeze
- Chest tightness from bronchospasm
How do you manage anaphylaxis?
- Remove trigger
- Maintain airway, give 100% O2
- Intramuscular adrenaline (0.5mg 1 in 1000)
- IV hydrocortisone 200mg
- IV chlorphenamine 10mg
Treat bronchospasm: NEB salbutamol
Treat laygenal oedema: NED adrenaline
How do you quantify a mild asthma attack?
- No features of severe asthma
- PEFR >75%
How do you quantify a moderate asthma attack?
- No features of severe asthma
- PEFR 50-75%
How do you quantify a severe asthma attack?
Any one of the following:
- PEFR 33-50%
- Cannot talk in complete sentences
- RR >25/min
- HR >110/min
How do you quantify a life threatening asthma attack?
Any one of the following
- PEFR <33%
- O2 sats <92%
- ABG pO2 <8kPa
- Cyanosis
- Poor respiratory effort
- Silent chest
- Exhaustion, confusion, hypotension, arrythmia
- pCO2 is normal
How do you quantify a near fatal asthma attack?
Features of life threatening asthma + RAISED pCO2
How do you manage an acute asthma attack?
- ABCDE
- Aim for sats 94-95% with oxygen
- do ABG if sats <92%
- 5mg nebulised salbutamol - can give back to back every 15 minutes
- 40mg prednisolone PO , or IV hydrocortisone if PO no possible
How do you manage a severe asthma attack?
- ABCDE
- Aim for sats 94-95% with oxygen
- do ABG if sats <92%
- 5mg nebulised salbutamol - can give back to back every 15 minutes
- 40mg prednisolone PO , or IV hydrocortisone if PO no possible
- Nebulised Ipratropium bromide 500micrograms
How do you manage a life threatening or near fatal asthma attack?
- Same as a severe asthma attack PLUS
- Urgen ITU / anaeasthetist assessment
- Consider portable CXR
- IV Aminophylline
- Consider IV salbutamol id nebulused route ineffective
How do you manage an exacerbation of COPD?
- ABCDE
- O2 via fixed performance face mask
- only aim for 88-92% sats is retaining CO2 (guided by ABG)
- Nebulised salbutamol and ipratropium
- Prednisolone 30mg STAT then OD for 7 days
- Abx if CRP/WCC is raised or purulent sputum
- CXR
- Consider IV aminophylline
- Consider NIV if type 2 respiratory failure
- Consider ITU if pH <7.2
What is pneumonia?
Consolidation on CXR with fever +/- purulent sputum +/- raised WCC and/ or CRP
How do you manage a patient with pneumonia?
- ABCDE
- Any features of sespsis start sepsis 6
- Otherwise treat with antibiotics as per CURB - 65
What is assessed in CURB-65?
How do you manage massive haemoptysis?
- ABCDE
- Lie patient on side of suspected lesion (if known)
- Oral tranexamic acid 5 days (or IV)
- STOP any NSAIDs, aspirin, anticoagulants
- Abx if any evience of respiratory tract infection
- Consider Vitamin K
- CT aortagram
What are the features of a tension Pneumothorax?
- Hypotension
- Tachycardia
- Deviated trachea away from affected side
- Mediastinal shift away from pneumothorax
How do you manage a tension pneumothorax?
- Large bore IV vannula into the 2nd ICS midclavicular line
- Chest drain into affected side
What are some of the symptoms of a PE?
- Chest pain
- SOB
- Haemoptysis
- Low cardiac output followed by collapse
What are some of the major risk factors for a PE?
- Surgery - especially abdo/pelvic, knee/hip replacement, any post op stay on ITU
- Obstetric - late pregnancy, C section
- Malignancy - abdo/ pelvis/ advanced/ metastatic
- Lower limb - fracture , varicose veins
- Reduce mobility
- Previously proven VTE
How do you manage a PE?
- ABCDE
- Oxygen if hypoxic
- Fluid resicitation if hypotensive
- Thrombolysis if massive PE confirmed on CTPA
- consider without scan if high clinica suspicion and cardiac arrest imminent
- check any contraindications first
- Fully anticoagulate
What is a massive PE? How is it managed?
PE with
- hypotension/ imminent cardiac arrest
- signs of right heart strain on CT/ ECHO
- Consider thrombolysis with IV alteplase
When is thrombolysis contraindicated?
- Haemorrhagic stroke or ischaemic stroke < 6months ago
- CNS neoplasia
- Recent trauma/ surgery
- GI bleed <1 month
- Bleeding disorder
- Aortic dissection
What are some of the complications of thrombolysis?
- Bleeding
- Hypotension
- Intracranial haemmorhage/ stroke
- Reperfusion arrythmias
- Systemic embolisation of thrombus
- Allergic reaction
