Respiratory Emergencies Quiz

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Questions and Answers

What is the primary indication for administering antibiotics in respiratory emergencies?

Purulent sputum and fever (correct)

Presence of wheezing and cough

Increased respiratory rate

Normal chest X-ray results

What type of non-invasive intervention is used when there is type II respiratory failure and elevated CO2 levels?

Nebulised oxygen with a venturi mask

Mechanical ventilation (MV)

Non-invasive ventilation (NIV) (correct)

Oxygen therapy with a face mask

Which of the following is an appropriate pharmacological treatment in respiratory management?

Antipyretics

Antihistamines

Corticosteroids (correct)

Decongestants

Which diagnostic tools can be utilized to exclude causes like pneumonia in respiratory emergencies?

Chest X-rays and ABGs Signup and view all the answers

What is the primary aim of delivering oxygen forcefully during non-invasive ventilation?

To improve oxygenation and eliminate CO2 Signup and view all the answers

What is a consequence of reducing breathlessness almost immediately?

Decreased mortality rates Signup and view all the answers

Which situation necessitates mechanical ventilation?

Severe life-threatening hypoxaemia Signup and view all the answers

Under what condition should a patient be admitted to the intensive care unit?

If they have severe dyspnoea refractory to emergency treatment Signup and view all the answers

What is a common characteristic of pulmonary embolism?

Non-specific clinical presentation Signup and view all the answers

What is a potential complication that might lead to the need for mechanical ventilation?

Inability to remove secretions Signup and view all the answers

What is the first line definitive procedure for managing bleeding in the airways?

Bronchial artery embolisation Signup and view all the answers

Which symptom is NOT typically assessed in a patient with suspected upper airway obstruction?

Heart rate Signup and view all the answers

Which condition is NOT a potential result of toxic inhalation?

Pneumothorax Signup and view all the answers

What factors can contribute to upper airway obstruction?

Foreign bodies Signup and view all the answers

Which of the following is a consequence of toxic inhalation affecting lung function?

Ciliary dysfunction Signup and view all the answers

Which of the following is a common cause of respiratory emergencies?

Pneumothorax Signup and view all the answers

What indicates a life-threatening asthma attack according to the predictors?

More than 2 hospitalizations in the past year Signup and view all the answers

What heart rate indicates potential severity in an acute severe asthma case?

More than 120 bpm Signup and view all the answers

What treatment is recommended to improve oxygen saturation in severe asthma?

Oxygen therapy to increase saturation above 90% Signup and view all the answers

Which of the following condition is less commonly associated with acute severe asthma?

Diabetes mellitus Signup and view all the answers

What does a peak expiratory flow rate (PEFR) of less than 1/3 predicted indicate?

Severe asthma attack Signup and view all the answers

Which adjunctive treatment can alleviate muscle fatigue in severe asthma cases?

Non-invasive ventilation (NIV) Signup and view all the answers

What should follow the initial treatment in severe asthma?

Reassessment to decide next steps Signup and view all the answers

What characterizes a massive pulmonary embolism?

Systolic blood pressure less than 90 mmHg Signup and view all the answers

Which of the following is a major risk factor for pulmonary embolism?

Immobilisation Signup and view all the answers

Which imaging modality is recommended for diagnosing pulmonary embolism in patients with renal failure?

VQ scan Signup and view all the answers

What is the primary treatment for submassive pulmonary embolism?

Administration of LMWH and IVC filters Signup and view all the answers

What defines massive haemoptysis?

Loss of 500ml of blood or more within 24 hours Signup and view all the answers

In the management of massive haemoptysis, which approach is emphasized?

Supportive care and stabilization Signup and view all the answers

What should be done if a patient experiencing massive haemoptysis is unstable?

Intubate if respiratory failure is present Signup and view all the answers

A low D-Dimer assay result suggests what?

Very low possibility of thrombosis Signup and view all the answers

Which of these is a characteristic of bronchiectasis, a common cause of haemoptysis?

Dilated bronchi causing mucus obstruction Signup and view all the answers

Why should caution be exercised when administering LMWH in certain patients?

Patients with recent surgery are at risk of bleeding Signup and view all the answers

What is a common early symptom of carbon monoxide poisoning?

Headache Signup and view all the answers

What management step should be prioritized in cases of toxic inhalation?

Secure the airway Signup and view all the answers

Which condition is the most common cause of spontaneous secondary pneumothorax?

Chronic obstructive pulmonary disease (COPD) Signup and view all the answers

What is a significant late presentation of carbon monoxide poisoning?

Personality change Signup and view all the answers

What might be noted during a physical examination of a patient with a tension pneumothorax?

Contralateral tracheal shift Signup and view all the answers

What is the primary purpose of using high flow oxygen in carbon monoxide poisoning?

Reverse carbon monoxide binding to hemoglobin Signup and view all the answers

Which sign is diagnostic for pneumothorax on a standard erect PA CXR?

Sharp white pleural line Signup and view all the answers

In managing a tension pneumothorax, what is the immediate action required?

Needle aspiration Signup and view all the answers

What kind of reaction is anaphylaxis categorized as?

Type 1 hypersensitivity reaction Signup and view all the answers

Which of the following is NOT commonly associated with pneumothorax?

Fever Signup and view all the answers

What is often a risk factor for spontaneous primary pneumothorax?

Tall stature Signup and view all the answers

What would indicate a need for hyperbaric oxygen therapy in carbon monoxide poisoning?

Severe neurological impairment Signup and view all the answers

Which procedure is NOT recommended for routine diagnosis of pneumothorax?

Expiratory views Signup and view all the answers

What effect does tension pneumothorax have on cardiac output?

Reduces it Signup and view all the answers

Study Notes

Respiratory Emergencies - ABCDE Approach

Airway: Assess airway patency, perform basic maneuvers (jaw thrust or head tilt/chin lift), check for foreign bodies (dentures, food), suction if needed, consider non-invasive ventilation (NIV), consult anaesthetist for invasive airway management.
Breathing: Check respiratory rate, SpO2, perform quick respiratory examination, consider arterial blood gas (ABG) analysis, chest X-ray (CXR) might be helpful.
Circulation: Check pulse, rhythm, and blood pressure, jugular venous pressure (JVP), capillary refill time, perform abdominal palpation, insert large-bore cannulas if hemodynamically unstable, take blood tests (CBC, U&E, INR, Group & save), ECG and attach to cardiac monitor, give normal saline fluid bolus unless there's heart failure/pulmonary oedema, auscultate heart.
Disability: Check blood glucose, temperature, perform AVPU assessment (Alert, Verbalising, Induce pain, Unresponsive - Glasgow Coma Scale), check pupils (reactive or unreactive), check for neck stiffness (meningitis), assess muscle tone and power, assess plantars.
Exposure: Assess skin integrity, check for any trauma or scars, assess pressure sores.

Dyspnea

Differentiate dyspnea from pain, fatigue, weakness, deconditioning.
Quantify and qualify dyspnea.
Use standardized scale (e.g., MRC dyspnea scale).
Possible causes include respiratory, cardiovascular, metabolic, or other disorders.

Respiratory Failure - Type 1

PaO2 less than 8 kPa with low or normal pCO2.
Most common cause is hyperventilation.
Causes: Vascular (pulmonary embolism, pulmonary oedema, intra-cardiac shunt, AV malformation, pulmonary arterial hypertension); Pulmonary (Asthma, Pneumonia, Pneumothorax).

Respiratory Failure - Type 2

pO2 less than 8 kPa with raised pCO2 more than 6 kPa.
Causes: Hypoventilation (NM disorders), reduced minute ventilation (neuromuscular disorders, CNS depression, chest wall abnormalities, morbid obesity), increased dead space ventilation (obstructive airway disease, asthma, COPD, upper airway obstruction, epiglottitis, tracheal tumours), alveolar abnormalities (secondary to type 1 respiratory failure such as severe pulmonary edema, pneumonia).

Acute Severe Asthma

Predictors of a life-threatening attack: Prior ICU stay, more than 2 hospitalizations or 3+ emergency visits in the past year, brittle asthma, poor perception of symptoms, frequent use of salbutamol, co-morbidities (cardiovascular/respiratory), smoking, overweight, psychiatric illnesses, social isolation, drug use.
Examination: Increased respiratory rate (RR >25), increased heart rate (HR >120), PEFR less than 1/3 predicted, type 2 respiratory failure on ABG, SPO2 less than 92%.

Severe COPD Exacerbation

Physical signs: Accessory muscle use, paradoxical chest movements, central cyanosis, peripheral oedema, haemodynamic instability, altered mental state, decreased air entry (wheezing, sometimes silent chest similar to asthma).
Tests: Pulse oximetry, arterial blood gas (ABG), chest X-ray (CXR), ECG, complete blood count (CBC), electrolytes, glucose, sputum culture and sensitivity.
Hospital referral criteria: marked increase in symptoms (particularly dyspnoea).

Pulmonary Embolism

Most common clinical presentation is non-specific.
Risk factors: Major (immobilisation, surgery, obstetrics, malignancy, lower limb fractures, previous DVT); Minor (CVS disease, COPD, oestrogens, obesity, long-distance travel, chronic diseases like CNS, CKD, thrombophilia).
Diagnosis: High clinical probability - Wells Score, D-dimer assay, V/Q scan, lower limb doppler ultrasound; CTPA (contrast enhanced CT).
Treatment: LMWH (low molecular weight heparin) subcutaneously, IVC filters (to prevent further embolisms).

Massive Haemoptysis

Loss of 500ml or more blood in 24 hours at a rate greater than 100ml/hour.
Causes: Bronchial carcinoma, pneumonia, tuberculosis (TB), bronchiectasis, cystic fibrosis (CF), aspergillomas.
Management: Supportive care (ABCDE), ICU admission, investigation for coagulopathy and haemodynamic instability to achieve haemostasis.

Upper Airway Obstruction

Causes: Foreign bodies (food, toys), tongue swelling, airway swelling.
Assessment: Airway movement, ability to speak, dyspnea, hypoxia, sounds (e.g., snoring, stridor), low oxygen levels on pulse oximetry.
Management: Ventilate if necessary, check for underlying problems, secure airway if required.

Toxic Inhalation

Causes: Inhalation of super-heated air, hazardous chemicals, combustion products, steam.
Management: Remove from exposure, rapid transport, secure airway (intubation if needed), correct hypoxia (high-flow oxygen), check for COHb (carbon monoxide), consider IV access and fluid resuscitation.

Carbon Monoxide Poisoning

Causes: Inhalation of carbon monoxide gas. Causes binding with haemoglobin.
Symptoms: Headache, irritability, loss of judgment, confusion, vomiting, flu-like symptoms, pink/red skin colour - early symptoms
Clinical presentations: Severe: pulmonary oedema, myocardial ischaemia, arrhythmias, seizures, coma - late symptoms
Treatment: Secure airway, remove from source, high-flow oxygen, hyperbaric chambers.

Pneumothorax

History: Acute onset pleuritic chest pain, usually at rest, with dyspnoea.
Symptoms: Can be out of proportion to extents of lung collapse, especially in secondary cases.
Examination: Hypoxaemia, major alterations in vitals. (seen in tension pneumothorax); hypotension, hyperexpanded hemithorax, reduced resonance, diminished breath sounds, increased resonance, decreased tactile fremitus. Contralateral tracheal deviation.
Causes: Trauma (broken ribs, hitting chest), spontaneous (primary/secondary - usually COPD patients or have underlying lung disease).

Spontaneous Primary Pneumothorax

Thought to be caused by the rupture of air-containing spaces within or near visceral pleura (usually at the apex).
High prevalence rate in males, smokers, tall stature, and genetic predisposition.
Underlying lung disease is typically absent.

Spontaneous Secondary Pneumothorax

Occurs in patients with underlying lung disease, such as COPD/emphysema.
Diagnosis: Standard erect PA CXR, expiratory or lateral decubitus views (if needed).
Treatment is largely supportive in most patients.

Tension Pneumothorax

Medical emergency.
Clinical diagnosis: Evidence of sudden deterioration, hypoxemia, tachycardia, contralateral tracheal shift, increased jugular venous pressure, and shock.
Causes: One-way valve phenomenon producing positive pleural pressure during most breaths, reducing venous return to the heart, and cardiac output.
Treatment: Immediate needle aspiration in the second intercostal space at the mid-clavicular line, followed by insertion of a chest drain.

Anaphylaxis

Type I hypersensitivity reaction - IgE mediated.
Clinical features: Vasodilation, bronchial mucosal oedema, bronchoconstriction.
Treatment: IV fluids, oxygen, hydrocortisone, adrenaline (epinephrine), chlorphenamine (antihistamine), nebulised bronchodilators, intubation (rarely).

Infection (Pleural or Parenchymal)

Can be pleural (empyema: pus in pleural space) requiring drainage and antibiotics, or parenchymal (pneumonia) requiring antibiotics and supportive care.
Symptoms: Pus in pleural space, pneumonia symptoms, access, sepsis.

Multi-organ Failure (ARDS)

Causes: Pulmonary insult resulting in non-cardiogenic pulmonary edema and hypoxaemia (refractory to oxygen therapy). Cytokines release fluid; cannot clear via diuretics leading to severe illness.
Criteria: Acute onset, bilateral infiltrates on CXR, low pulmonary capillary wedge pressure (PCWP) (<18 mmHg), normal left atrium and ventricle, refractory hypoxaemia.
Treatment: Supportive, continuous fluid support, intubation/ventilation if needed, inotropes (to support heart function).

Superior Vena Cava Obstruction (SVC)

Causes: Lung cancer or lymphoma are the most common, and SVC invasion, SVC compression, SVC thrombosis.
Clinical features: Headache, dyspnea, facial plethora (redness), venous distention of the neck, and upper extremity edema (unilateral, usually)
Diagnosis: Contrast-enhanced CT thorax.
Treatment: Dexamethasone, radio-chemo, stenting (radiological intervention) to restore patency.

Barotrauma

Trapped gas due to changes in pressure during diving.
Treatment: Varies depending on severity of injury and symptoms. May include supportive measures or surgical intervention.

Pulmonary Renal Syndromes

Symptoms: Alveolar haemorrhage, dyspnea, pleuritic chest pain, cough, wheezing; hematuria; oliguria; renal failure; malaise, lethargy, fever, arthralgia, anorexia, weight loss;
Causes: Small vessel vasculitides (e.g., Wegener's granulomatosis, microscopic polyangiitis, Goodpasture syndrome, Churg-Strauss syndrome).
Treatment: Immunosuppressants, plasma exchange, renal replacement therapy.

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Description

Test your knowledge on respiratory emergencies with this quiz. Covering indications for antibiotics, non-invasive interventions, pharmacological treatments, and diagnostic tools, this quiz is essential for medical professionals. Assess your understanding of critical situations and management strategies in respiratory care.