Final year‎ > ‎

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

Comments