Please enable JavaScript.

Coggle requires JavaScript to display documents.

Respiratory - Coggle Diagram

- - - - family history
      - atopy
  - - - worse at night & early morning
  - - - FEV1/FVC < 0.7
  - - - ABCDE
        
        oxygen
      - nebulised bronchodilators
        
        salbutamol 5mg
        
        ipratropium bromide 500 micrograms (SAMA)
      - oral prednisolone 40–50mg 5 days
      - if this doesn't work
        
        IV magnesium sulphate
        
        refer to specialist
        
        IV aminophylline
        
        IV salbutamol
        
        consider HDU/ICU
  - - - exacerbation
        
        moderate
        
        increasing symptoms
        
        severe
        
        one of
        
        PEFR 33–50% best/predicted
        
        RR 25/min or more
        
        HR 110/min or more
        
        can't complete sentences in one breath
        
        life-threatening
        
        PEFR < 33% best/predicted
        
        sats < 92%
        
        normal CO2
        
        exhaustion
        
        altered mental status
        
        silent chest
        
        fatal
        
        raised CO2
        
        need ventilation
- - - - infective
        
        most commonly bacterial
        
        Streptococcus pneumoniae
        
        Haemophilus influenzae
        
        Moraxella catarrhalis
      - non-infective
        
        air pollution
        
        smoking
      - ABCDE
        
        oxygen (target 88–92%, Venturi mask)
        
        nebulised bronchodilators
        
        salbutamol 2.5mg
        
        ipratropium bromide 500 micrograms
        
        antibiotics
        
        amoxicillin
        
        doxycycline
        
        prednisolone 30mg 5 days
        
        not working
        
        non-invasive ventilation (BiPAP)
        
        referral to ICU
        
        invasive ventilation
  - - - smoking
      - occupational dusts
      - air pollution
      - increasing age
      - alpha-1 antitrypsin deficiency
        
        younger patients
        
        also causes cirrhosis
    - - hypoxic drive
  - - - FEV1/FVC < 0.7
    - - none
    - - secondary polycythaemia (lots of RBCs)
        
        prone to blood clots
  - - - NRT
    - - pneumococcal (once)
      - flu (annually)
  - - - type 2 respiratory failure (hypoxic & hypercapnic)
      - worsening symptoms
      - infective
        
        fever
- - - - usually right lower/middle lobe
    - - Streptococcus pneumoniae
      - Haemophilus influenzae
      - Staphylococcus aureus
    - - Pseudomonas
      - Staphylococcus aureus
    - - old age
      - immunosuppression
      - alcohol excess
      - underlying respiratory disease
  - - - bronchial breathing
      - crackles
  - - - FBC
      - U&Es
      - CRP
    - - follow-up to check that focal consolidation is resolved after treatment
  - - - Confusion
      - Urea > 7 mmol/L
      - Respiratory Rate ≥ 30
        
        score
        
        0–1: home
        
        2: admission
        
        ≥3: ITU
      - Blood pressure: systolic < 90 mmHg or diastolic ≤ 60 mmHg
      - age ≥ 65
  - - - oxygen
      - fluids
    - - oral amoxicillin 1g 8 hrly OR oral doxycycline 200mg stat, then 100mg daily (5 day course)
        
        consider extending if symptoms not improved after 3 days
      - oral/IV amoxicillin 1g 8 hrly + oral clarithromycin 500mg 12 hrly (until atypical infection excluded) OR oral doxycycline 100mg 12 hrly (5–7 day course)
        
        IV required
      - IV amoxicilin 1g 8 hrly + oral clarithromycin 500mg 12 hrly (until atypical excluded)
        
        switch to oral doxycycline 100mg 12 hrly or amoxicillin 1g 8 hrly _ clarithromycin 500mg 12 hrly (until atypical excluded)
      - aspiration pneumonia
        
        oral
        
        amoxicillin 1g 8hrly + metronidazole 400mg 8hrly
        
        IV
        
        amoxicillin 1g 8hrly + metronidazole 500mg 8hrly
        
        7 day course
        
        true penicillin allergy
        
        clarithromycin 500mg 12hrly (oral/IV) + metronidazole 8hrly (oral 400mg or IV 500mg)
- - - - adenocarcinoma (commonest in non-smokers)
        
        paraneoplastic syndrome
        
        hypertrophic pulmonary osteoarthropathy
        
        inflammation in hand joints
      - squamous cell carcinoma
        
        paraneoplastic syndrome
        
        finger clubbing
      - large cell
    - - very aggressive, poor prognosis
      - paraneoplastic syndrome
        
        ectopic ACTH secretion
        
        siADH
  - - - unexplained haemoptysis
      - unexplained & persistent (>3 wks)
        
        change in cough
        
        new cough
        
        dyspnoea
        
        chest/shoulder pain
        
        anorexia
        
        weight loss
        
        chest signs
        
        hoarseness
        
        refer via H&N pathway if nothing else to suggest lung cancer
        
        fatigue (in a smoker aged over 40)
        
        chest infection (also if recurrent)
        
        supraclavicular lymphadenopathy
      - new finger clubbing
      - cervical lymphadenopathy
      - thrombocytosis (if no suggestion of other cancer)
- - - - stasis
        
        recent surgery
        
        immobility
        
        long haul flight
        
        obesity
      - endothelial damage
        
        lower limb trauma
        
        hip fractures
      - hypercoagulability
        
        active cancer
        
        pregnancy
        
        sepsis
        
        COCP
  - - - breathlessness
      - pleuritic chest pain
      - haemoptysis
    - - unilateral swollen leg that is tender & may have some red/blue discoloration
      - collateral veins visible
  - - - usually normal
    - - sinus tachycardia
      - right heart strain
      - S1Q3T3
    - - clinical signs & symptoms of DVT (3)
      - PE top/tied top diagnosis (3)
      - HR > 100 (1.5)
      - immobilisation ≥ 3 days or surgery in previous 4 wks (1.5)
      - previous PE/DVT (1.5)
      - haemoptysis (1)
        
        score
        
        more than 4: high probability
        
        CT pulmonary angiogram or ventilation-perfusion scan
        
        ≤4: low probability
        
        D-dimer
        
        raised D-dimer
        
        CTPA
      - malignancy with treatment within 6 mths or palliative (1)
  - - - oxygen
    - - massive PE
        
        thrombolysis (e.g. alteplase)
    - - DOAC (e.g. apixaban)
      - LMWH
      - renal impairment
        
        unfractionated heparin
- - - - underlying lung disease
  - - - breathlessness
      - pleuritic chest pain
    - - inspection
        
        tachypnoea
        
        respiratory distress
        
        accessory muscles of respiration
      - palpation
        
        tension
        
        tracheal deviation away from pneumothorax
        
        reduced chest expansion on side of pneumothorax
      - percussion
        
        hyperresonance
      - auscultation
        
        quiet breath sounds
  - - - emergency needle decompression (2nd ICS MCL)
    - - wait & see
- - - - < 30g/L protein
      - heart failure
      - liver failure (hypoalbuminaemia)
      - nephrotic syndrome
    - - 30g/L protein
      - parapneumonic
        
        pneumonia
        
        TB
      - lung cancer
      - PE
    - - Light's criteria
        
        pleural fluid protein/serum protein > 0.5
        
        pleural fluid LDH/serum LDH > 0.6
        
        pleural fluid LDH > 2/3 upper limit of normal LDH
  - - - inspection
        
        tachypnoea
      - palpation
        
        tracheal deviation
        
        reduced chest expansion
      - percussion
        
        stony dull percussion
      - auscultation
        
        reduced breath sounds