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Flashcards in TOSCE Deck (10)
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1

List some uses of NIPPV


COPD exacerbation
Acute pulmonary oedema
Acute hypoxaemic respiratory failure
Acute exacerbation of asthma/cf
Acute respiratory failure in the immunocompromised

2

Contraindications to NIPPV

Haemodynamic instability
GCS<10
Inability to cooperate

Cardiac arrest
Unstable arrhythmia

Respiratory arrest
Upper airway obstruction
Unprotected airway

High aspiration risk
Inability to clear secretions
Facial trauma/deformity
Neurological surgery
Facial surgery

3


pH 7.27 (7.35 - 7.45)
paCO2 14.4 ka (4.7- 6 kPa)
paO2 6.9 kPa (11 – 13 kPa)
HCO3 30 (22-26 mmol/L)

Describe this ABG result.

Acidotic hypercapnic respiratory failure/Type 2 respiratory failure with partial metabolic compensation suggesting a component of chronicity to hypercapnoea.

4

Emphysema

Emphysema is a chronic permanent dilatation of the airways distal to the terminal bronchioles resulting in a gradual destruction of the alveolar septa leading to a decreased ability to oxygenate the blood.

5

chest exam finding of patient with COPD

Decreased chest expansion
Hyperresonant percussion note
Decreased breath sounds
Wheeze
Crepitations

6

when do you give NIPPI in COPD

NIPPV, if two of:
Moderate to severe dyspnoea
pH <7.35, Pco2>4.5
RR>25

7


List some complications of NIPPV

Skin irritation/breakdown/infection
Discomfort
Mask leaks
Eye irritation
Sinus pain/congestion
Abdominal discomfort
Nosocomial pneumonia
Pneumothorax

8

complication of NSCLC


• Pleural effusion
• Post-obstructive pneumonia
• PE
• Pericardial effusion
• SVC obstruction
• Metastases (brain, bone, liver, adrenal)

9

SVC obstruction why a complication in lung cancer

syndrome may be due to compression of the superior vena cava by tumour or mediastinal lymph nodes or thrombosis

10

treatment of systemic scl


Treatment of localized sclerotic skin ultraviolet-A (UVA) light therapy, potent topical glucocorticoids, calcipotriol (a vitamin D analog), and methotrexate