14.02.26 Resp / Emergency / Vasculitis revision

Acute asthma hOSPITAL: Oxygen Salbutamol Pred / Hydrocortisone Ipratropium Theophyline Anaesthetist Life-threatening: Magnesium Polyarteritis nodosa Lots of nodules on blood vessels Need biopsy and angiogram => Accelerated phase hypertension Vicious cycle of kidney damage Livideo reticularis Orchiditis Respiratory failure Type 2 Easy - Hypoventilation Type 1 High V/Q PE Cardiac Low V/Q Pneuomonia = SHUNTING Diffusion abnormality ILD ARDS Lymphangitis Aa gradient Uses IDEALISED alveolar [oxygen] Derived value Assumes lung units are homogeneous Based on how much CO2 the lungs are able to get rid of (i.e. on PaCO2) Normally <1.5 kPa  But rises with age Causes of raised Aa gradient: Diffusion impairment Low V/Q Shunt 5 Causes of Hypoxaemia (1-3 have an elevated A-a Gradient) V/Q Mismatch  PNA, CHF, ARDS, atelectasis, etc. Shunt PFO, ASD, PE, pulmonary AVMs Alveolar Hypoventilation Interstitial lung dz, environmental lung dz, PCP PNA Hypoventilation  COPD, CNS d/o, neuromuscular dz, etc Low FiO2 High altitude Management of pneumothorax Vasculitides Notes Check for muscle weakness as well as ECG changes in hyperkalaemia Causes of haemoptysis with renal impairment ANCA +ve vasculitis Goodpasture's Causes of saddle-nose Wegener's Leprosy Syphilis Cocaine Churg-Strauss causes EOSINOPHILIA Often >8 Causes asthma, rhinitis etc PE can eventually lead to a LOW V/Q HYPOXIA Cytokine release affects surfactant production / function of nearby alveoli