clinical features of acute moderate asthma exacerbation
PERK < 75% predicted
clinical features of acute moderate asthma exacerbation
PERK 33-50% predicted
can not finish full sentence
RR >25
HR > 110
clinical features of acute life-threatening asthma exacerbation
33 92 chest
PERK < 33
O2 < 92
Cyanosis Hypotension Exhaustion - normal or low PCO2 Silent chest Tachycardia
management of acute asthmatic attack?
O SHIT ME
o2 salbutamol - 2.5-5mg neb Hydrocortisone - 100mg IV Ipratropium - 500mcg neb Theophylline - aminophylline infusion 1g in 1L saline 0.5ml/kg/h
Magnesium sulfate
escalate care
clinical features of acute COPD exaecbeation?
- Cough
- SOB
- Tachypnoea
- ↑ Sputum production/appearance change/viscosity change
- Wheeze/coarse crackles
- Accessory muscle use and lip-pursing (increases end expiratory pressure – prevents collapse of airways at low pressure)
- Assess hyperinflation (barrel chest)
- Evidence of hypercapnia:
- Tremor
- CO2 retention flap
- Bounding pulse
- Peripheral vasodilation
- Drowsiness
- Confusion
management of acute COPD in hospital
O SHIT -if in hospital
Oxygen - aim for 88-92 via venturi mask
Salbutamol - 5mg neb
Hydrocortisone - 100mg IV
Ipratropium bromide 500mcg neb
Theophylline -0.5mg/kg/h
ABx
BiPAP - respiratory acidosis persists despite max standard medical treatment for > 1 h
escalate
management of acute COPD at home
- Prednisolone 30mg for 7 days
- Regular inhalers/home nebs – salbutamol and corticosteroid
- Abx - if evidence of infection
- Airway clearance technique
aetiology of hyperventilation (panic attack)
panic disorder anxiety astham metabolic acidosis - compensatory hyperventilation PE pulmopnary oedema hypoxia fever aspirin overdose
clinical features of hyperventilation in panic disorder
usually paroxysmal - rapid onset on anxiety, lasting 20-30 mins
SOB chest pain paraesthesia - usually both arms (Ca2+ ) perioral tingling (Ca2+ ) dizziness depresonalisation derealisation tinnitus weakness palpitatioons use of accessory muscles inspiratory > expiratory phase
investigation for hyperventilation
ABG - inc O2, respiratory alkalosis
ECG
pulmonary function test
management of hyperventilation
explaination of the nature of the condition with anxiety
rebreathing into a paper bag -only use when diagnosis is certain
relaxation techniques
O2
benzo if severe
propranolol
complications of hyperventilations
secondary hypocalcaemia - due to Ca dissociation is shifted towards the unionised, bound form
- Trousseaus’s sign - muscle spasm in the hand, tips of fingers and thumb apposed and the fingers straight
- chvostek’s sign
what is acute bronchitis
refers specifically to the infections causing inflammation in the bronchial airways
a self-limiting LRTI
aetiology of acute bronchitis
- Smoking
* Infection – viral esp (Influenza A/B, parainfluenza, RSV, adenovirus, rhinovirus)
clinical features of acute bronchitis
- Cough >5 days – normally productive (clear, white or discoloured sputum)
- Runny nose/sore throat precedes
- Wheeze/rhonchi/course crackles
- Fever
what is the criteria used to diagnose acute bronchitis
MacFarlane
a) an acute illness of < 21 days
b) cough as predominant symptom
c) at least 1 other LRTI eg sputum production, wheezing, chest pain
d) no alternative explanation for the symptoms
management of acute bronchitis
- If without significant wheezing, cough associated with increased activity or nocturnal cough – observe and symptomatic relief
- Significant wheezing, cough associated with increased activity or nocturnal cough – SABA
abx if systemically unwell
when will you consider using VQ scan
used in pt with CKD, contrast allergy or at risk from radiation eg young and pregnant
what is idiopathic pulmonary fibrosis
no know cause pulmonary fibrosis
RF - FHx, smoking, older age, male
SOB, on exertion, non productive cough, clubbing, end expiratory fine crackles, weight loss, fatigue, malaise
what is bronchiectasis
permanent dilatation of the bronchi due to destruction of the elastic and muscular components of hte bronchial wall
- chronic productive cough, large volumes produced worse when lying down
- haemoptysis
- high pitch inspiratory squeaks
- SOB
- fever
signet ring sign on CT - bronchi appears bigger than vessel on CT
