Pulmonary oedema mx
- Sit pt up, 2. Iv furosemide, 3.nitrate infusion OR morphine infusion if SOB+++
Asthma acute Mx
- High flow 02
- salbutamol nebulisers
- ipratroprium bromide nebulisers - iv mgSo4
– ICU ref/specialist
COPD mx (chronic)
- SABA or SAMA (e.g. ipratroprium)
2.
If steroid responsive: corticosteroid + LABA (fluticasone/salmeterol)
If steroid unresponsive: LAMA + LABA (tioptoprium/salmeterol) - LABA + LAMA _ ICS
When is BIPAP used?
T2 RF to facilitate CO2 exhalation
(IPAP > EPAP)
Which resp disease is this?
Reticulo-nodular shadowing as in interstitial lung disease
Interstitial lung disease causative drugs
- Nitrofurantoin
- MTX
- Amiodarone
- Chemo drugs
What does this CXR show?
Bilateral hilar lymphadenopathy as in sarcoidosis
Features of sarcoidosis
- Dry cough
- Malaise
- Hyperca features
- Erythema nodosum
Biopsy results for sarcoidosis
Granulomas (clusters of macrophages, lymphocytes, etc.)
Myasthenic crisis and features
Acute resp failure where forced vital capacity (FVC) <1L + need for ventilators support
- Use of accessory muscles
- Weak cough
Severe pneumonia + multi focal consolidation initial Mx
IV Co-Amox and clarithro
What do for airway of an alert pt with respiratory acidosis
Non-invasive ventilation
Idiopathic pulmonary fibrosis features
- Dry cough
- Increasing SOBOE
- Finger clubbing
- On ausc, bibasal creps
Bronchiectasis features
- Younger pt usually
- SOB worsening
- Productive cough
- Recurrent chest infx during childhood
- Bilat scattered wheeze
- Coarse inspiratory crackles
Empyema
1) What that
2) Features
3) Ix
4) Mx
1) collection of pus in the pleural space
2) SOB, pleural effusion
3) Pleural effusion: purulent aspirate and microscopy shows growth
4) Chest tube (catheter thoracotomy) drainage
Obstructive sleep apnoea
1) Features
2) Mx
1)
- Heavy snoring
- Day time sleepiness ++ (Epworth sleepiness score)
- Often plus weight
2) - CPAP
- +/- weight loss & diabetes mx
TB
1) Features
2) CXR finding
3) Next diagnostic ix?
1) - Malaise
- Weight loss
- Haemoptysis
2) Consolidation with cavitation
3) Sputum microscopy
Pneumothorax v lobar collapse
- Pneumothorax is more rapid onset with severe syx ++
Which gram negative bacteria is likely to be causing pneumonia in CF patient?
Pseudomonas aeruginosa
Lung ca w keratin pearls
SCC
Bronchiectasis and features
Abnormal widening bronchi -> excess mucous & damaged cilia
Productive cough + dull percussion
Abx for legionella
Clarithromcyin
Abx for klebsiella
Ceftriaxone/cefotaxime
COPD acute mx
- ±O2
- Neb salbutamol + neb ipratropium bromide
- IV hydrocortisone + PO pred (5 days)
- Amox/co-amox
- Further support: aminophylline/ITU/NIV)
