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