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