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?

<p>Chest X-rays and ABGs (A)</p> Signup and view all the answers

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

<p>To improve oxygenation and eliminate CO2 (D)</p> Signup and view all the answers

What is a consequence of reducing breathlessness almost immediately?

<p>Decreased mortality rates (D)</p> Signup and view all the answers

Which situation necessitates mechanical ventilation?

<p>Severe life-threatening hypoxaemia (A)</p> Signup and view all the answers

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

<p>If they have severe dyspnoea refractory to emergency treatment (B)</p> Signup and view all the answers

What is a common characteristic of pulmonary embolism?

<p>Non-specific clinical presentation (C)</p> Signup and view all the answers

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

<p>Inability to remove secretions (C)</p> Signup and view all the answers

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

<p>Bronchial artery embolisation (D)</p> Signup and view all the answers

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

<p>Heart rate (B)</p> Signup and view all the answers

Which condition is NOT a potential result of toxic inhalation?

<p>Pneumothorax (B)</p> Signup and view all the answers

What factors can contribute to upper airway obstruction?

<p>Foreign bodies (A)</p> Signup and view all the answers

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

<p>Ciliary dysfunction (A)</p> Signup and view all the answers

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

<p>Pneumothorax (C)</p> Signup and view all the answers

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

<p>More than 2 hospitalizations in the past year (C)</p> Signup and view all the answers

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

<p>More than 120 bpm (A)</p> Signup and view all the answers

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

<p>Oxygen therapy to increase saturation above 90% (B)</p> Signup and view all the answers

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

<p>Diabetes mellitus (A)</p> Signup and view all the answers

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

<p>Severe asthma attack (A)</p> Signup and view all the answers

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

<p>Non-invasive ventilation (NIV) (B)</p> Signup and view all the answers

What should follow the initial treatment in severe asthma?

<p>Reassessment to decide next steps (B)</p> Signup and view all the answers

What characterizes a massive pulmonary embolism?

<p>Systolic blood pressure less than 90 mmHg (D)</p> Signup and view all the answers

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

<p>Immobilisation (B)</p> Signup and view all the answers

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

<p>VQ scan (A)</p> Signup and view all the answers

What is the primary treatment for submassive pulmonary embolism?

<p>Administration of LMWH and IVC filters (D)</p> Signup and view all the answers

What defines massive haemoptysis?

<p>Loss of 500ml of blood or more within 24 hours (B)</p> Signup and view all the answers

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

<p>Supportive care and stabilization (C)</p> Signup and view all the answers

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

<p>Intubate if respiratory failure is present (C)</p> Signup and view all the answers

A low D-Dimer assay result suggests what?

<p>Very low possibility of thrombosis (D)</p> Signup and view all the answers

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

<p>Dilated bronchi causing mucus obstruction (D)</p> Signup and view all the answers

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

<p>Patients with recent surgery are at risk of bleeding (A)</p> Signup and view all the answers

What is a common early symptom of carbon monoxide poisoning?

<p>Headache (D)</p> Signup and view all the answers

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

<p>Secure the airway (D)</p> Signup and view all the answers

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

<p>Chronic obstructive pulmonary disease (COPD) (C)</p> Signup and view all the answers

What is a significant late presentation of carbon monoxide poisoning?

<p>Personality change (D)</p> Signup and view all the answers

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

<p>Contralateral tracheal shift (C)</p> Signup and view all the answers

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

<p>Reverse carbon monoxide binding to hemoglobin (A)</p> Signup and view all the answers

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

<p>Sharp white pleural line (B)</p> Signup and view all the answers

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

<p>Needle aspiration (D)</p> Signup and view all the answers

What kind of reaction is anaphylaxis categorized as?

<p>Type 1 hypersensitivity reaction (D)</p> Signup and view all the answers

Which of the following is NOT commonly associated with pneumothorax?

<p>Fever (A)</p> Signup and view all the answers

What is often a risk factor for spontaneous primary pneumothorax?

<p>Tall stature (C)</p> Signup and view all the answers

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

<p>Severe neurological impairment (A)</p> Signup and view all the answers

Which procedure is NOT recommended for routine diagnosis of pneumothorax?

<p>Expiratory views (D)</p> Signup and view all the answers

What effect does tension pneumothorax have on cardiac output?

<p>Reduces it (B)</p> Signup and view all the answers

Flashcards

Severe Asthma

A life-threatening condition characterized by severe constriction of the airways, making it difficult to breathe.

Increased Respiratory Rate (RR)

Increased respiratory rate, often above 25 breaths per minute, indicating difficulty breathing.

Peak Expiratory Flow Rate (PEFR)

A measure of how well a person can exhale air from their lungs, often less than 1/3 of the expected value in severe asthma.

Salbutamol

A high dose beta agonist that dilates the airways to improve airflow.

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Anticholinergic (Ipratropium)

A type of medication used to relax the muscles of the airways and improve breathing.

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Hydrocortisone

An anti-inflammatory medication that reduces swelling and inflammation in the airways.

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NIV

Non-invasive ventilation, a device that helps to support breathing without the need for a breathing tube.

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Type 2 Respiratory Failure

A life-threatening complication of asthma where the lungs fail to adequately exchange oxygen and carbon dioxide.

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Non-Invasive Ventilation (NIV)

A non-invasive treatment where a machine pushes air into the lungs, helping the body get rid of CO2 and take in oxygen.

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Mechanical Ventilation (MV)

A treatment where a machine breathes for a patient, allowing oxygen to enter the lungs and help them breathe.

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Bronchodilator

A substance that opens up the airways in the lungs, making it easier to breathe.

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What are the benefits of NIV?

NIV is often used to help people with breathing problems breathe easier. It is often used in the emergency setting as a first-line treatment for respiratory distress before mechanical ventilation.

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When is mechanical ventilation needed?

If NIV fails to improve breathing, it is time to consider mechanical ventilation. Mechanical ventilation uses a machine to help a person breathe. This is used for patients who are unable to breathe on their own or whose lungs are failing.

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What are the challenges of mechanical ventilation?

Mechanical ventilation is a serious intervention that requires careful monitoring and management. Patients on mechanical ventilation need to be carefully monitored for complications such as lung injury, infection, and bleeding.

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Pulmonary Embolism

A pulmonary embolism is a blood clot that travels to the lungs and blocks a pulmonary artery, preventing blood flow to the lungs. Symptoms can include shortness of breath, chest pain, and coughing.

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Bronchial Artery Embolisation

A procedure that stops the blood supply to a particular area, often used for bleeding in the bronchial arteries. It involves inserting a catheter through the femoral artery and navigating it to the affected area to deliver embolic material.

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Hypoxia

The inability of the body to transport oxygen to the tissues efficiently. It is a common condition in patients with severe respiratory emergencies.

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Bronchiolitis

A condition where the airways in the lungs become narrower, making it difficult to breathe. It can be caused by various factors, such as inflammation, bronchospasm, and reduced surfactant production.

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Toxic Inhalation

A condition resulting from inhaling harmful substances, such as toxic chemicals, combustion products, or superheated air. It can lead to a range of respiratory problems.

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Haemodynamic compromise

A condition where the heart is unable to adequately pump blood throughout the body, often caused by a pulmonary embolism (PE).

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Massive PE

A type of PE where the blood clot is large enough to significantly impact blood flow and cause symptoms like chest pain, breathlessness, or low blood pressure.

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Submassive PE

A type of PE where the blood clot is smaller and doesn't severely affect blood flow, but still causes symptoms like discomfort or shortness of breath.

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Immobilisation

A common risk factor for PE, often associated with prolonged periods of inactivity, such as bed rest after surgery or long journeys.

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CVS disease

A risk factor for PE involving medical conditions that affect the heart and blood vessels, increasing the chances of clot formation.

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D-Dimer assay

A diagnostic test that measures the amount of a protein fragment in the blood, often elevated in the presence of blood clots, but not specific for PE.

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CTPA

A specialized imaging test using a CT scan to visualize the pulmonary arteries and identify any blood clots present.

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Haemoptysis

The medical term for coughing up blood, a serious symptom that can be caused by various conditions.

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Massive Haemoptysis

A type of Haemoptysis considered severe, involving the loss of a large amount of blood over a short period, often associated with significant bleeding.

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Bronchial carcinoma

A common cause of Haemoptysis, often associated with lung cancer.

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Carbon Monoxide Poisoning

A condition where carbon monoxide binds to haemoglobin in the blood, preventing oxygen from reaching the body's cells.

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Pneumothorax

The presence of air in the space between the lung and the chest wall, causing the lung to collapse.

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Tension Pneumothorax

A type of pneumothorax where pressure builds up in the chest cavity, compressing the heart and lungs.

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Anaphylaxis

A life-threatening allergic reaction that causes a rapid drop in blood pressure, swelling, and difficulty breathing.

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Spontaneous Primary Pneumothorax

A type of pneumothorax that occurs in a patient without any underlying lung disease.

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Spontaneous Secondary Pneumothorax

A type of pneumothorax that occurs in a patient with pre-existing lung disease.

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Traumatic Pneumothorax

A type of pneumothorax caused by trauma, such as broken ribs.

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Mannan Sign

A clicking or crunching sound heard with each heartbeat, associated with tension pneumothorax.

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Erect PA CXR

A standard chest X-ray used to diagnose pneumothorax.

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Pleural Line

A white pleural line on a chest X-ray, indicating the presence of a pneumothorax.

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Contralateral Tracheal Deviation

A condition in which the trachea (windpipe) shifts to the opposite side of the chest, often seen in tension pneumothorax.

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Needle Aspiration

A procedure to remove air from the pleural space using a needle.

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Chest Drain

A tube inserted into the chest to drain air and allow the lung to re-expand.

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Hyperbaric Chamber Therapy

A treatment that involves placing a patient in a pressurized chamber filled with pure oxygen.

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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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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.

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