resp

• COPD - still breathless despite using SABA/SAMA and no asthma/steroid responsive features → add a LABA + LAMA
• BiPAP is the correct answer. The patient is having an exacerbation of COPD as evidenced by worsening breathlessness, wheeze, tachypnoea and type 2 respiratory failure. Despite immediate maximum standard medical treatment, he remains acidotic with hypercapnia. The most appropriate management is to commence the patient on BiPAP. 
• Continuous positive airway pressure (CPAP) . This is a type of non-invasive ventilation but principally it helps with oxygenation by delivering positive pressure, which helps maintain open airways. It is used in conditions where the principal pathophysiology is type 1 respiratory failure i.e. pulmonary oedema/covid pneumonitis.
• bipab vs cpap

  • Indications:
  • CPAP: Primarily used for type 1 respiratory failure conditions such as pulmonary oedema and obstructive sleep apnoea.
  • BiPAP: Indicated for type 2 respiratory failure or conditions requiring ventilatory support, such as COPD exacerbations, neuromuscular disorders, and severe asthma.
  • Ventilation Support:
  • CPAP: Primarily aids in oxygenation by preventing airway collapse but does not provide significant ventilatory assistance.
  • BiPAP: Enhances both oxygenation and ventilation, making it suitable for patients with hypoventilation.
• All cases of pneumonia should have a repeat chest X-ray at 6 weeks after clinical resolution
• Mining occupation, upper zone fibrosis, egg-shell calcification of hilar nodes → ? silicosis
• What is Pneumoconiosis?


  Pneumoconiosis refers to a group of interstitial lung diseases caused by the inhalation of inorganic dust, leading to lung inflammation and fibrosis.
• What is Silicosis?


  Silicosis is a specific type of pneumoconiosis resulting from exposure to crystalline silica, commonly found in industries such as mining, construction, and stone cutting.
• Pathophysiology of Silicosis


  Inhaled silica particles provoke an inflammatory response, leading to macrophage activation. This results in the release of pro-inflammatory cytokines and fibrogenic mediators, causing collagen deposition and progressive lung scarring.
• Types of Silicosis


  • Chronic silicosis: Develops after 10-20 years of low-level exposure; presents with nodular opacities on chest X-ray.
  • Acute silicosis: Occurs after high-level exposure over months; presents with rapid onset dyspnoea and diffuse alveolar damage.
  • Accelerated silicosis: Develops within 5-10 years of heavy exposure; features are similar to chronic silicosis but progress more rapidly.
• Clinical Features of Silicosis

  Symptoms include cough, dyspnoea, and chest pain. Advanced disease may lead to respiratory failure and pulmonary hypertension.
• Diagnosis of Silicosis


  Diagnosis is based on occupational history, clinical symptoms, imaging (CXR or CT), and sometimes lung biopsy.
• Treatment of Silicosis


  There is no cure; management focuses on symptom relief, prevention of further exposure, and treatment of complications like infections or pulmonary hypertension.
• What is respiratory alkalosis?

  Respiratory alkalosis is a primary disturbance in acid-base balance characterized by decreased arterial carbon dioxide tension (PaCO2) and increased blood pH. It typically arises from hyperventilation, which can be triggered by various factors.
• What are the physiological causes of respiratory alkalosis?

  Physiological causes of respiratory alkalosis include:

  • Anxiety or panic attacks
  • Pain
  • Fever
  • Hypoxia (e.g., high altitude)
• What are the pathological causes of respiratory alkalosis?

  Pathological causes of respiratory alkalosis include:

  • Pneumonia
  • Asthma exacerbation
  • COPD exacerbation with compensatory hyperventilation
• What are the drug-induced causes of respiratory alkalosis?

  Drug-induced causes of respiratory alkalosis include:

  • Salicylate overdose (early phase)
  • CNS stimulants (e.g., amphetamines)
• What are the clinical symptoms of respiratory alkalosis?

  Patients with respiratory alkalosis may present with symptoms such as light-headedness, tingling in extremities, and muscle cramps.
• How is respiratory alkalosis diagnosed?

  Respiratory alkalosis is diagnosed through arterial blood gas analysis, which shows elevated pH (>7.45) and low PaCO2 (<35 mmHg).
• How is respiratory alkalosis managed?

  Management of respiratory alkalosis focuses on treating the underlying cause. For acute cases, rebreathing into a paper bag may help restore CO2 levels.
• The most common organism causing infective exacerbations of COPD is Haemophilus influenzae
• blood pressure makes the diagnosis of tension pneumothorax more likely than simple pneumothorax
• Pneumothorax can occur following high pressure non-invasive ventilation
• What does a low FEV1 indicate?

  • Potential airway narrowing
  • Difficulty breathing out quickly
• What is the typical FEV1 value for healthy adults?

  1. 4 liters
• What does FVC measure?

  • Total volume of air exhaled after a deep breath
  • Indicates overall lung capacity
• What is the typical FVC value for healthy adults?

  About 5 liters
• What does FEV1% represent?

  • Ratio of FEV1 to FVC
  • Expressed as a percentage
  • Indicates airflow limitations
• How is FEV1% calculated?

  $FEV1\% =$$(FEV1 \div FVC) \times 100$
• The triangle of safety for chest drain insertion involves the base of the axilla, lateral edge pectoralis major, 5th intercostal space and the anterior border of latissimus dorsi
• Re-positioning the patient upright will allow patients to breathe easier and more comfortably and should be attempted first in any breathless patient