Respiratory for finals
Created by: Dr Chen
JUNE 1, 2024
,Contents
Oxygen therapy ........................................................................................................................................................................................................... 3
Pulmonary function tests ............................................................................................................................................................................................ 6
Acute bronchitis ........................................................................................................................................................................................................ 11
Pag
Chronic Obstructive Pulmonary Disease (COPD) ...................................................................................................................................................... 13
|1
Smoking cessation .................................................................................................................................................................................................... 21
Asthma ...................................................................................................................................................................................................................... 22
Acute asthma attack ................................................................................................................................................................................................. 27
Consolidation on CXR ................................................................................................................................................................................................ 30
Pneumonia ................................................................................................................................................................................................................ 31
Cryptogenic organizing pneumonia .......................................................................................................................................................................... 36
Pulmonary eosinophilia ............................................................................................................................................................................................ 38
Diffuse Alveolar Haemorrhage Syndromes ............................................................................................................................................................... 40
Allergic BronchoPulmonary Aspergillosis .................................................................................................................................................................. 42
Interstitial Lung Disease (ILD) ................................................................................................................................................................................... 45
Idiopathic Pulmonary Fibrosis (IPF) .......................................................................................................................................................................... 47
Extrinsic Allergic Alveolitis (EEA) / Hypersensitivity pneumonitis ............................................................................................................................. 49
Pneumoconiosis ........................................................................................................................................................................................................ 52
Progressive massive fibrosis (PMF) ........................................................................................................................................................................... 53
Bronchiectasis ........................................................................................................................................................................................................... 56
Cystic fibrosis ............................................................................................................................................................................................................ 59
Sarcoidosis .............................................................................................................................................................................................................. 62
Pulmonary Hypertension .......................................................................................................................................................................................... 65
Pleural Effusion ......................................................................................................................................................................................................... 70
Pneumothorax .......................................................................................................................................................................................................... 73
Tension pneumothorax - medical emergency ........................................................................................................................................................... 76
Pulmonary Embolism (PE) ......................................................................................................................................................................................... 85
Pharyngitis/Tonsillitis ................................................................................................................................................................................................ 89
Sinusitis ..................................................................................................................................................................................................................... 90
Epiglottitis ................................................................................................................................................................................................................. 91
Whooping cough ....................................................................................................................................................................................................... 92
Acute laryngo-tracheobronchitis (Croup) ................................................................................................................................................................. 93
,Tuberculosis ............................................................................................................................................................................................................. 94
Respiratory failure .................................................................................................................................................................................................... 99
Acute Respiratory Distress Syndrome (ARDS) / Acute lung injury .......................................................................................................................... 100
Methaemoglobinaemia........................................................................................................................................................................................... 104
Carbon monoxide poisoning ................................................................................................................................................................................... 105
Pag
|2
, Oxygen therapy
Always note when prescribing oxygen:
- Type of oxygen delivery system (nasal cannula, Venturi mask)
- Inspired oxygen concentration or flow rate
- Target oxygen saturation
- Monitoring
o Observe patient’s colour, RR, level of consciousness, O2 sats, ABG Pag
o Patient with non rebreath mask (NRBM) should have continuous pulse oximetry
|3
Management:
Presentation of type 2 respiratory failure:
- All acutely unwell patients = reservoir mask at 15 l/min to maintain optimal
- 67yo women
tissue oxygenation and prevent organ failure
- Drowsy
o Hypoxia is more dangerous than hypercapnia and will cause
- Cough green sputum
patients to have cardiac arrest if severe or prolonged.
- Past medical history of asthma
o Exceptions where O2 is only needed if hypoxic – only give
- Smokes 15 cigarettes a day
additional oxygen if O2 sats below target range
▪ MI, ACS On examination:
▪ Stroke - Oxygen sats 95%
▪ Obstetric emergencies - Alert
▪ Anxiety related hyperventilation - Widespread wheezing – lower airway, high
- Acutely unwell patient at risk of CO2 retention with no history of pitched
respiratory acidosis e.g. COPD, bronchiectasis, NMD, morbid obesity - No crackles
o Prior to availability of blood gases = NRBM oxygen - pH low
o If ABG shows CO2 retention = use a 28% Venturi mask at 4l/min + - Normal PaO2
aim for an oxygen saturation of 88-92% - High PaCO2 level
o If ABG shows normal pCO2 = adjust target range to 94-98% - Elevated bicarbonate levels
Management:
Oxygen saturation targets
- Type 2 respiratory failure
• Acutely ill patients = 94-98%
- Treatment:
• Patients at risk of hypercapnia (e.g. COPD patients) = 88-92%
o Cautious oxygenation
• Oxygen should be reduced in stable patients with satisfactory oxygen o Bronchodilators, steroids and antibiotics
saturation
o 1 hour of medical treatment then
repeat ABG
Oxygen delivery system
o if don’t respond, give NIV
- Simple Face Masks
o Deliver an oxygen concentration between 35-60%, with a flow rate of 5–10L/min
o Minimum flow rate should be 5 l/min (to eliminate the build-up of exhaled CO2).
o Cant measure how much O2 patient is receiving, worst way to deliver
o For any given flow rate, the inspired oxygen concentration achieved will vary, as it depends upon the rate and depth of the
patient’s breaths and the patient's minute volume.
▪ A high minute volume will lower the inspired oxygen concentration, as increased inspiratory flow rates will cause an
in-drawing of air so diluting the oxygen delivered
▪ Conversely slower breathing will increase the inspired oxygen concentration.
o In patients requiring prolonged oxygen therapy on the ward, humified oxygen should be considered – this uses a similar face
mask, but an additional humidification device helps to prevent drying of the patient’s secretions, which may significantly
worsen their respiratory problem.
- Nasal cannulae
o Capable of delivering an inspired oxygen concentration of between 24-50% depending on the flow rate of the oxygen (1-6
L/min).
o The inspired oxygen concentration achieved will vary, as it depends upon the oxygen flow rate and the depth and rate of the
patient’s breaths
o Maximum flow rate is 4 l/minute because higher rates can cause nasal mucosal drying and epistaxis
- Venturi masks
o Deliver precisely controlled percentages of high flow oxygen from 24-60%
o The valves are colour coded according to the percentage of oxygen delivered
o Useful in patients where a specific oxygen concentration is required for example in COPD patients.
Created by: Dr Chen
JUNE 1, 2024
,Contents
Oxygen therapy ........................................................................................................................................................................................................... 3
Pulmonary function tests ............................................................................................................................................................................................ 6
Acute bronchitis ........................................................................................................................................................................................................ 11
Pag
Chronic Obstructive Pulmonary Disease (COPD) ...................................................................................................................................................... 13
|1
Smoking cessation .................................................................................................................................................................................................... 21
Asthma ...................................................................................................................................................................................................................... 22
Acute asthma attack ................................................................................................................................................................................................. 27
Consolidation on CXR ................................................................................................................................................................................................ 30
Pneumonia ................................................................................................................................................................................................................ 31
Cryptogenic organizing pneumonia .......................................................................................................................................................................... 36
Pulmonary eosinophilia ............................................................................................................................................................................................ 38
Diffuse Alveolar Haemorrhage Syndromes ............................................................................................................................................................... 40
Allergic BronchoPulmonary Aspergillosis .................................................................................................................................................................. 42
Interstitial Lung Disease (ILD) ................................................................................................................................................................................... 45
Idiopathic Pulmonary Fibrosis (IPF) .......................................................................................................................................................................... 47
Extrinsic Allergic Alveolitis (EEA) / Hypersensitivity pneumonitis ............................................................................................................................. 49
Pneumoconiosis ........................................................................................................................................................................................................ 52
Progressive massive fibrosis (PMF) ........................................................................................................................................................................... 53
Bronchiectasis ........................................................................................................................................................................................................... 56
Cystic fibrosis ............................................................................................................................................................................................................ 59
Sarcoidosis .............................................................................................................................................................................................................. 62
Pulmonary Hypertension .......................................................................................................................................................................................... 65
Pleural Effusion ......................................................................................................................................................................................................... 70
Pneumothorax .......................................................................................................................................................................................................... 73
Tension pneumothorax - medical emergency ........................................................................................................................................................... 76
Pulmonary Embolism (PE) ......................................................................................................................................................................................... 85
Pharyngitis/Tonsillitis ................................................................................................................................................................................................ 89
Sinusitis ..................................................................................................................................................................................................................... 90
Epiglottitis ................................................................................................................................................................................................................. 91
Whooping cough ....................................................................................................................................................................................................... 92
Acute laryngo-tracheobronchitis (Croup) ................................................................................................................................................................. 93
,Tuberculosis ............................................................................................................................................................................................................. 94
Respiratory failure .................................................................................................................................................................................................... 99
Acute Respiratory Distress Syndrome (ARDS) / Acute lung injury .......................................................................................................................... 100
Methaemoglobinaemia........................................................................................................................................................................................... 104
Carbon monoxide poisoning ................................................................................................................................................................................... 105
Pag
|2
, Oxygen therapy
Always note when prescribing oxygen:
- Type of oxygen delivery system (nasal cannula, Venturi mask)
- Inspired oxygen concentration or flow rate
- Target oxygen saturation
- Monitoring
o Observe patient’s colour, RR, level of consciousness, O2 sats, ABG Pag
o Patient with non rebreath mask (NRBM) should have continuous pulse oximetry
|3
Management:
Presentation of type 2 respiratory failure:
- All acutely unwell patients = reservoir mask at 15 l/min to maintain optimal
- 67yo women
tissue oxygenation and prevent organ failure
- Drowsy
o Hypoxia is more dangerous than hypercapnia and will cause
- Cough green sputum
patients to have cardiac arrest if severe or prolonged.
- Past medical history of asthma
o Exceptions where O2 is only needed if hypoxic – only give
- Smokes 15 cigarettes a day
additional oxygen if O2 sats below target range
▪ MI, ACS On examination:
▪ Stroke - Oxygen sats 95%
▪ Obstetric emergencies - Alert
▪ Anxiety related hyperventilation - Widespread wheezing – lower airway, high
- Acutely unwell patient at risk of CO2 retention with no history of pitched
respiratory acidosis e.g. COPD, bronchiectasis, NMD, morbid obesity - No crackles
o Prior to availability of blood gases = NRBM oxygen - pH low
o If ABG shows CO2 retention = use a 28% Venturi mask at 4l/min + - Normal PaO2
aim for an oxygen saturation of 88-92% - High PaCO2 level
o If ABG shows normal pCO2 = adjust target range to 94-98% - Elevated bicarbonate levels
Management:
Oxygen saturation targets
- Type 2 respiratory failure
• Acutely ill patients = 94-98%
- Treatment:
• Patients at risk of hypercapnia (e.g. COPD patients) = 88-92%
o Cautious oxygenation
• Oxygen should be reduced in stable patients with satisfactory oxygen o Bronchodilators, steroids and antibiotics
saturation
o 1 hour of medical treatment then
repeat ABG
Oxygen delivery system
o if don’t respond, give NIV
- Simple Face Masks
o Deliver an oxygen concentration between 35-60%, with a flow rate of 5–10L/min
o Minimum flow rate should be 5 l/min (to eliminate the build-up of exhaled CO2).
o Cant measure how much O2 patient is receiving, worst way to deliver
o For any given flow rate, the inspired oxygen concentration achieved will vary, as it depends upon the rate and depth of the
patient’s breaths and the patient's minute volume.
▪ A high minute volume will lower the inspired oxygen concentration, as increased inspiratory flow rates will cause an
in-drawing of air so diluting the oxygen delivered
▪ Conversely slower breathing will increase the inspired oxygen concentration.
o In patients requiring prolonged oxygen therapy on the ward, humified oxygen should be considered – this uses a similar face
mask, but an additional humidification device helps to prevent drying of the patient’s secretions, which may significantly
worsen their respiratory problem.
- Nasal cannulae
o Capable of delivering an inspired oxygen concentration of between 24-50% depending on the flow rate of the oxygen (1-6
L/min).
o The inspired oxygen concentration achieved will vary, as it depends upon the oxygen flow rate and the depth and rate of the
patient’s breaths
o Maximum flow rate is 4 l/minute because higher rates can cause nasal mucosal drying and epistaxis
- Venturi masks
o Deliver precisely controlled percentages of high flow oxygen from 24-60%
o The valves are colour coded according to the percentage of oxygen delivered
o Useful in patients where a specific oxygen concentration is required for example in COPD patients.
