Respiratory Failure, Pneumothorax and Interstitial Lung Disease

Give 3 symptoms associate with pulmonary exacerbations:

1) dyspnoea

2) green sputum

3) cough

What two common signs are exhibited in severe COPD?

1) pursed lip breathing

2) CO2 flap

What is the purpose of pursed lip breathing in severe COPD?

it provides positive pressure to small airways to stop them from collapsing

What causes CO2 flap in the hands?

CO2 retention or overuse of blue inhaler

What are the 3 types of oxygen therapy?

1) long term oxygen therapy (LTOT)

2) short term oxygen therapy

3) ambulatory oxygen therapy

When should LTOT be used?

when patients have a Pao2 below 7.3 kPa when stable as well as one of the following

1) secondary polycythaemia

2) nocturnal hypoxaemia

3) peripheral oedema

4) pulmonary hypertension

What causes peripheral oedema in respiratory disease?

hypoxia causes right side heart failure causing pulmonary hypertension and a collection of blood in lower vessels

What are the blood gases like in type 1 respiratory failure?

hypoxia and normal PCO2 (V/Q mismatch)

What are the blood gases like in type 2 respiratory failure?

hypoxia and hypercapnia due to inadequate alveolar ventilation

In what case can you give too much O2 to a hypoxic person:

some with chronic respiratory disease develop such severe hypercapnia that they switch to a hypoxia drive for ventilation meaning if this hypoxia is treated, they may stop breathing

What are the 2 key COPD phenotypes:

1) pink puffer

2) blue bloater

Describe the pink puffer COPD phenotype:

maintains relatively normal blood gas tension at the expense of breathlessness often with skeletal muscle wasting

Describe the blue bloater COPD phenotype:

less breathless at the expense of abnormal blood gas tension and right side heart failure. They are often more sensitive to oxygen therapy due to a hypoxic drive and chronic hypercapnia

Give 6 general treatments for type 2 respiratory failure:

1) inhaled/ oral steroids

2) beta agonists

3) mucolytics

4) antibiotics

5) anticholinergic agents

6) flu vaccination

How does non-invasive ventilation help treat respiratory failure?

it provides positive pressure to airways, stopping them from collapsing, without intubation

What is a pneumothorax?

the collapse of a lung due to it no longer being attached to the wall

What is a tension pneumothorax?

pneumothorax caused by a tear in the visceral pleura, forming a one way valve that allows air into the pleural space but prevents it from returning to the lung

How will pneumothorax present on a CXR?

one side of the chest will be dark

How does pneumothorax affect the heart?

progressive build up of pressure in the pleural space pushes the mediastinum to the opposite side of the chest, resulting in obstruction to venous return to the heat, causing reduced cardiac output and hypotension

Give 8 signs of pneumothorax:

1) tachypnoea

2) bruising

3) tenderness over ribs

4) trachea deviated away from pneumothorax

5) surgical emphysema

6) hyper-resonant on percussion

7) breath sounds decrease

8) raised central venous pressure

What is surgical emphysema?

fibrosis of connective tissue due to air from pleural space moving into tissue

How does surgical emphysema sound upon percussion?

like popping bubble wrap

How is pneumothorax commonly treated?

chest drain

What is the underwater seal when using a chest drain?

it stops air from returning to the lungs

What treatment is used for pneumothorax in healthier pateints?

aspiration

How long should be given between traumatic pneumothorax recovery and flying?

2 weeks

What are the common causes of primary spontaneous pneumothorax?

family history and smoking

What are the common causes of secondary spontaneous pneumothorax?

disease such as COPD and CF

True or false: the risk of spontaneous pneumothorax recurrence increases after each case

true

What physiological issue often causes spontaneous pneuomothorax?

rupturing of small, sub-pleural blebs

What is rheumatoid arthritis?

a chronic, systemic inflammatory disorder that affects synovium and symmetrical small joints via erosion

Is interstitial lung disease obstructive or restrictive?

restrictive

How does lung tissue affected by interstitial lung disease appear on a CT scan?

honey combed fibrosis due to scarring

Describe the FEV1/FEC in RESTRICTIVE lung diseases such as interstitial lung disease

FEV1 is reduced due to smaller lung volume and FVC is largely reduced meaning the values become more similar, increasing the ratio

Give 2 symptoms of interstitial lung disease:

1) dry cough

2) progressive breathlessness

Give a common sign of interstitial lung disease:

Clubbing of nails

How is rheumatoid arthritics linked to interstitial lung disease?

methotrexate (an RA drug) can cause hypersensitivity pneumonitis causing fibrosis

Give 3 respiratory conditions other than methotrexate lung that are associated with rheumatoid arthritis:

1) pulmonary nodules

2) pleural effusions

3) bronchiectasis

Give 6 side effects of steroids like methotrexate:

1) thrush

2) bruising

3) weight gain

4) Cushing's

5) increased infection risk

6) osteoporosis

What tissue is most affected by interstitial lung disease?

lung parenchyma