Respiratory Diseases and Treatments

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Questions and Answers

What is a primary purpose of oxygen therapy in treating COPD?

To increase airway resistance

To improve lung elasticity

To reduce mucus production

To enhance oxygen absorption in the bloodstream (correct)

Which type of mechanical ventilator mode allows a patient to trigger spontaneous breaths?

Volume-cycled mode

Assist-control mode (correct)

Intermittent mandatory ventilation

Pressure support mode

What complication is characterized by scarring and thickening of lung tissue that hinders oxygen transfer?

Chronic bronchitis

Emphysema

Asthma exacerbation

Pulmonary fibrosis (correct)

Which ECMO setting is primarily used for respiratory support?

Veno-venous (V-V) ECMO Signup and view all the answers

What is the main function of bronchodilators in COPD treatment?

To dilate airways and improve airflow Signup and view all the answers

What is the primary effect of oxygen therapy in pulmonary edema treatment?

Improves patient stabilization Signup and view all the answers

Which symptom is typically observed in a patient with a spontaneous pneumothorax?

Hyperresonance on percussion Signup and view all the answers

What is the appropriate initial management for tension pneumothorax?

Needle aspiration at the 2nd intercostal space Signup and view all the answers

Which medication is commonly used for acute asthma exacerbations?

All of the above Signup and view all the answers

In managing COPD, what is the target SpO2 range according to the guidelines?

88% to 92% Signup and view all the answers

What is a crucial first step in the management of a patient with suspected cardiac arrest?

Ensure a patent airway Signup and view all the answers

During an acute asthma attack, which delivery method is preferred for administering bronchodilators?

Inhalation via nebulizer Signup and view all the answers

What is the safest site for needle aspiration in a tension pneumothorax?

5th intercostal space midaxillary line Signup and view all the answers

What should be administered first in the case of bradycardia with SpO2 below 6.5 mmol/l?

Oxygen therapy Signup and view all the answers

Which of the following ECG changes indicates moderate hyperkalemia?

Peaked T-waves Signup and view all the answers

In the management of irregular narrow complex tachycardia, what should be considered if evidence of heart failure is present?

Anticoagulant Signup and view all the answers

What is the first-line treatment for broad complex tachycardia with an irregular rhythm?

Magnesium 2g over 10min Signup and view all the answers

What is the most serious clinical presentation of venous thromboembolism?

Pulmonary embolism leading to cardiac arrest Signup and view all the answers

If ECG changes persist with symptoms of hyperkalemia, what should be administered next?

Insulin - Glucose IV infusion Signup and view all the answers

What is indicated for a patient with bradycardia if suspected hyperkalemia is present?

Empirical treatment for arrhythmias Signup and view all the answers

In case of narrow complex tachycardia with a regular rhythm, which treatment should be initiated if vagal maneuvers fail?

Verapamil or beta-blockers Signup and view all the answers

Study Notes

COPD

Chronic Obstructive Pulmonary Disease (COPD) is a chronic lung disease that causes obstruction of airflow from the lungs
COPD includes chronic bronchitis and emphysema
Chronic bronchitis involves inflammation of the airways causing swelling and mucus buildup
Emphysema affects the small air sacs (alveoli) in the lungs, causing them to collapse
COPD often involves damage to both airways and alveoli

Pulmonary Fibrosis

Pulmonary fibrosis is scarring and thickening of the tissues surrounding the alveoli
This makes it difficult for oxygen to pass into the bloodstream

Mechanical Ventilation

Mechanical ventilators help patients breathe, especially when oxygen levels are low (pneumonia) or carbon dioxide levels are high (COPD)
Intermittent Mandatory Ventilation (IMV) delivers a set number of breaths at a fixed volume, but allows patients to trigger spontaneous breaths
Continuous Positive Airway Pressure (CPAP) uses mild air pressure to keep airways open during sleep, treating sleep disorders like apnea

Extracorporeal Membrane Oxygenation (ECMO)

ECMO is a life support system for patients with severe heart or lung failure
It acts as an artificial heart and lung, oxygenating the blood and removing carbon dioxide
Types of ECMO include veno-venous (V-V), veno-pulmonary (V-P), and veno-venoarterial (V-VA)

Pulmonary Edema Treatment

Treatment includes disorder-specific and symptomatic approaches
Disorder-specific treatment targets the underlying cause, like arrhythmias, myocardial infarction, hypertensive crisis, or stroke
Symptomatic treatment includes:
- Nitroglycerine (vasodilator) to relax blood vessels
- Diuretics to lower blood pressure, increase urine output, and reduce pressure on the heart
- Oxygen therapy

Spontaneous Pneumothorax

A sudden onset of chest pain, often unilateral (one-sided)
Emphysema can be a common underlying condition
Symptoms can include:
- Absent breathing sounds on one side
- Hyperresonant percussion (may be absent when the air space is narrow)
- Absence of lung sliding on ultrasound

Tension Pneumothorax

An increasing pressure within the chest cavity, compressing the heart, major blood vessels, and lungs
Symptoms include:
- Chest pain
- Difficulty breathing
- Shock
- Neck vein distention
- Cyanosis
Treatment:
- Needle aspiration in the 2nd intercostal space, midclavicular line, or 4-5th intercostal space, midaxillary line (midaxillary is safer)
- Finger thoracostomy

Acute Asthma Exacerbation

Treatment involves:
- Beta mimetics for inhalation (salbutamol)
- Hydrocortisone intravenously (prednisolone)
- Magnesium sulfate
- Theophylline (infuse slowly, risk of blood pressure drop)

Asthma & COPD Guidelines: Cardiac Arrest Prevention

Airway:
- Ensure a patent (open) airway
- Treat life-threatening hypoxia with high-flow oxygen
- Titrate oxygen therapy with pulse oximetry (SpO2 94-98% for asthma; 88-92% for COPD)
Breathing:
- Assess respiratory rate, accessory muscle use, ability to speak, pulse oximetry, percussion, and breath sounds
- Request chest X-ray
- Provide nebulized bronchodilators (oxygen-driven for asthma, consider air-driven for COPD)
- Administer steroids (Prednisolone or hydrocortisone)
- Consider IV magnesium sulfate for asthma
Circulation:
- Assess heart rate and blood pressure
- Attach an ECG
- Obtain vascular access
- Consider IV fluids
- Treat arrhythmias

Tachycardias

Broad Complex Tachycardia
- Irregular rhythm: Magnesium 2g over 10 minutes
- Regular rhythm:
  1. Vagal maneuvers
  2. Adenosine 6mg rapid IV (if unsuccessful, +12mg, if unsuccessful, +18mg) If ineffective:
    - Procainamide 10-15mg/kg over 20 minutes
    - Amiodarone 300mg IV over 10-60 minutes
- If ineffective: Synchronized shock (up to 3 attempts)
Narrow Complex Tachycardia
- Irregular rhythm (probable atrial fibrillation):
  1. Control heart rate with beta-blockers or calcium channel blockers (diltiazem)
  2. Consider digoxin or amiodarone if heart failure
  3. Anticoagulant if duration >48 hours
- Regular rhythm:
  1. Vagal maneuvers
  2. Adenosine 6mg rapid IV (if unsuccessful, +12mg, if unsuccessful, +18mg)
- If ineffective:
  - Verapamil, calcium channel blockers (diltiazem), or beta-blockers
- If ineffective: Synchronized shock (up to 3 attempts)

Bradycardia

Approach:
- Provide oxygen if SpO2 <90%
- Exclude pseudohyperkalemia (false high potassium levels)
- Treat hyperkalemia if suspected
Hyperkalemia:
- Mild (K+ 5.5-5.9 mmol/l) and severe (K+ >6.5 mmol/l): Monitor serum potassium and blood glucose, assess underlying cause, and prevent recurrence
- Moderate (K+ 6.0-6.4 mmol/l):
 - If ECG changes (peaked T waves, flat/absent P waves, broad QRS, bradycardia, or VT)
 - 10ml 10% calcium chloride IV or 30ml 10% calcium gluconate IV
 - If ECG changes persist: Same treatment as below
 - If no ECG changes:
 - Insulin-glucose IV infusion (25g glucose with 10 units insulin over 15-30 minutes IV)
 - If pretreatment blood glucose <7.0 mmol/l: 10% glucose infusion at 50ml/hour

Respiratory Failure

Cardiac arrest due to acute pulmonary embolism is the most serious consequence of venous thromboembolism, often originating from a deep vein thrombosis (DVT)
Diagnosis of "confirmed pulmonary embolism" involves considering the probability of PE and the need for specific treatment
Key steps for diagnosis:
- Clinical history and assessment
- Information on past medical history, predisposing factors, and medication that may support a diagnosis of PE

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Description

This quiz covers key concepts related to Chronic Obstructive Pulmonary Disease (COPD), pulmonary fibrosis, and mechanical ventilation techniques. Test your knowledge on the causes, symptoms, and management strategies for these respiratory conditions. Understand the importance of ventilation support in critical care.