CSI 1B Breathlessness Slide Deck and Notion Link in description
Summary
This on-demand teaching session investigates a case of breathlessness. It offers valuable insights for medical professionals into noting comorbidities and delves into statistical analysis reflecting how closely certain factors are associated with death in such cases. It provides a practical guide on understanding radiographs and interpreting hazard ratios. The training also simplifies the process of reading arterial blood gases (ABG) reports, highlighting how to detect respiratory and metabolic acidosis. The session additionally educates on the management of such cases, both non-pharmacological and pharmacological, and the treatment of exacerbations. The course ultimately wraps up by explaining the concept of Cor Pulmonale using a relatable analogy of a traffic jam and road closure. This teaching offers crucial knowledge to better understand, manage, and treat patients suffering from breathlessness.
Description
Learning objectives
- By the end of this session, learners will be able to identify the statistical links between comorbidities and breathlessness, including their prevalence and potential for causing death.
- Learners will develop the skills to interpret radiographs relevant to respiratory ailments, focusing specifically on signs of hyperinflation, bullae, a flattened diaphragm, and lung cancer.
- Participants will be able to read and analyze Arterial Blood Gas (ABG) reports, discerning differences between respiratory and metabolic acidosis and recognizing compensation mechanisms.
- The medical audience will be able to identify management strategies for breathlessness, discussing both non-pharmacological and pharmacological treatments, and distinguishing between different types of respiratory failure and appropriate treatments.
- Finally, learners will be able to conceptualize and explain the relationship between breathlessness and edema, specifically in relation to cor pulmonale, and apply this understanding to potential treatment approaches.
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A Case of Breathlessness Madhav ManojTask 1 – Comorbidities and Statistics• Bigger the circle, the greater the prevalence • Statistically significant = inside circle • Closer to centre, stronger the association with deathWhich behaviour is most significantly associated with jealousy in dogs?• Hazard Ratio = how related ‘x’ is to ‘y’ • Look for those that are ‘statistically significant’ • Look for greatest hazard ratio (therefore greatest association)Task 2Reading Radiographs • RIPE • ABCDE • Zonal Approach• Hyperinflation • Bullae • Flattened Diaphragm• Lung Cancer! • Opacity in left middle zone• Pleural Effusion! • ‘Meniscus sign’Task 3-ABGsABGs Simplified • 1. Check oxygen status • 2. Read the pH • 3. Check the CO2 • 4. Check the HCO3 • Consider Base Excess • Respiratory vs Metabolic Acidosis? Compensation Mechanisms • Your body will fight to fix pH imbalanceSummarise this ABG report.1. pH is low –ACIDOSIS 2. CO2 is high – therefore, it is respiratory acidosis 3. HCO3 - is normal – no compensationSummarise this ABG report.1. pH is low - Acidosis 2. HCO3 is low – metabolic acidosis 3. CO2 is low – some respiratory compensation (not completed as pH is low)Respiratory Failure • The compensation mechanisms only help for so long… • Type 1 = Hypoxemic • - treated with CPAP • Type 2 = Hypercapnic • - treated with NIV (BiPAP)FEEDBACKTask 4 - ManagementNon - Pharmacological Stop smoking! (every patient must be advised to do this) Nutritional support Offer flu vaccine Pulmonary rehabilitationPharmacological Step 1:Starting with a SABA/SAMA Step 2: Add a LABA/LAMA • Step 3: IF daily symptoms affect their activities of daily living then a 3 month trial of LAMA + LABA + ICS should be considered.Treating Exacerbations • Oxygen (24% O2 via Venturi mask: SpO2 88-92%), • Antibiotics - Amoxicillin or Doxycycline • Steroids + Bronchodilators • • If no improvement – consider breathing support • - give NIV (BiPAP since COPD is type 2 respiratory failure)CPAP vs BiPAPvsAP BiPAPTask 6 - OedemaCor Pulmonale • Backup of blood in venous system • i.e. Traffic Jam because of road closure • - cars begin to move slowly due to congestion • - some cars will deviate off road and take other routes to get to destinationTHANKS FOR LISTENING!