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Ok, so we're gonna get started. So, um, hi, my name is Shruti. I've done some of the uh previous lectures as well. And uh today I'm gonna be doing acute respiratory um conditions. So let's get started. So, usual session structure, we'll have etiology, history, presentation investigations and then finding management. Um, and these are the main conditions that we're gonna be covering. So acute bronchitis, influenza pe pneumothorax, A R DS, respiratory arrest and then COVID-19. Um, we weren't really touch on that in too much depth, but um, there's a little summary slide for you guys to sort of read up on later. Um So let's start off by going through an SBA. So, um I'm just gonna give you a minute, have, have a read and have a think what your answer might be. And then we'll do a little bit of content and we'll come back to the question afterwards. Ok, I'm gonna move on and we'll come back to this after we've got a little bit of the content, as I said. So let's start off with acute bronchitis. So acute bronchitis is an upper respiratory tract infection. This is um specifically infection of the bronchi um and usually it's a viral infection. Um but it can be bacterial. So the main organisms that you need to know are vir virus, parainfluenza influenza A or B respiratory sensitive A virus and Coronavirus. Um So, these are the main causes of acute bronchitis and these are all viruses. Um less commonly, it can be caused by plasma pneumonia, border tele pertussis, um chlamydia pneumonia. Um but these aren't very common causes. So you can see that what happens basically in acute bronchitis is that the walls of the um bronchi become inflamed as a result of the infection. And you can see it leads to narrowing and therefore difficulty breathing and all the associated symptoms. Um The issue with questions is that it might be difficult to kind of guess which particular organism caused it. Um But there are some like little subtle associations that are worth remembering. So for example, um respiratory syncytial virus is something that you see more commonly in Children. Um like not even Children, kind of like infants. So, um if it's, if the question is about a baby or something, then you're more likely to think more about um RSV um as opposed to something else. So you want to kind of look at hints in the question to determine which of the viruses. But more commonly, it's probably like gonna be the case that they'll give you one common virus and then other less common causes and then you need to select the one that's kind of the most likely cause of the bronchitis. Um, risk factors are smoking, cystic fibrosis, COPD, all of the risk factors make sense. So, the problem here is that we've got restricted airflow in acute bronchitis. So if you're, if you're a smoker, if you've got cystic fibrosis, you got COPD. Your, your baseline airway function is already kind of not great. And so further narrowing is me, means that you're gonna be, you know, more susceptible to issues. So that's why these, um, three are particular risk factors, um, in terms of signs and symptoms. So you get a nonproductive or minimally productive cough. So this in general kind of helps you to determine between kind of like viral versus bacterial. So, um, if it's nonproductive, um, sorry, if it's productive, you're more, you're more thinking of like a bacterial cause. Um But here, it's generally like a dry cough and it might last weeks you get dyspnea. So that's difficulty breathing. Um, and it's from like chest pain or tightness. Um, and you get a wheezing and so on and then you might have a mild fever and the, the keyboard here is mild. So, um, if it's, you know, a very high temperature, again, you're thinking more of like bacterial pneumonia, et cetera. Um, but if it's a little bit more mild, ok, maybe it's an upper respiratory tract infection like, um, acute bronchitis. Now, investigations wise, um, it is based on clinical presentations. You, you don't really do, um, like chest x rays and things, but you might do it if you're kind of not sure. Is this a bronchitis? Is this a pneumonia? So, if there's like a little bit of uncertainty, you might still do an X ray just to rule it out. Um, you might do it in elderly patients because obviously they can decompensate much faster. Um, if there's like a persistent cough for more than six weeks and that's not very normal. So, acute bronchitis coughs usually last few weeks. But by six weeks you'd expect that they'd go, if not, there might be something else going on. So again, we'd, uh, want to have a look at that. That could be anything, it could be cancer, it could be anything really. Um, and also if you've got a history of lung conditions, COPD and so on again, just because they're more susceptible to, um, deteriorating, um, and sputum, um, microscopy and culture isn't really something that you do in bronchitis, it's not like, um, in pneumonia. So, with acute bronchitis itself, you don't, there's no investigations, it's based off your clinical examination, but you might do examination. So you might do investigations to rule out other things if you're not quite sure, management wise. Um, well, in normal healthy patients who just, you know, have an episode of acute bronchitis, it's just sort of painfully paracetamol and ibuprofen and hydration and rest um And if the cough is lasting, you know, more than two weeks, you can give them inhaled corticosteroids to help with the narrowing of the airway. Um, but then you've also got patients who have underlying conditions like COPD and asthma and they need oral antibiotics. Um, just because they're more likely um to deteriorate. Um, and the antibiotics we use is amoxicillin for seven days and only if they're allergic to this, then you would use Doxycycline. So, Doxycycline is a second line treatment both for seven days. So first line would be amoxicillin. Second line would be Doxycycline. Um, and that's something that's worth remembering. Um, because it's an easy SBA, um, also if they're wheezing and, uh, like if they've got an underlying condition, you might use salbutamol. Um, and you can give antitussives which are basically anti cough medications. Um, if cough is kind of something that's affecting sleep and, you know, preventing them from getting better. So, if we come back to that SB that we had a look at, so, uh, Lucy's been having a dry cough and shortness of breath. So, um, remember we said that, uh, acute bronchitis is more likely to be dry unlike pneumonia. Um, and shortness of breath, we said we talked about dyspnea, it's lasted five days. Um, and she's been feeling generally unwell, but she doesn't have a fever. So you might not have a fever, you might have a fever, but it will be very mild, it won't, the, the main thing is it won't be, you know, very high fever. Um And she has no medical history of nope. Um So what should the GP do? So we discussed that the, the management um for people who, you know, don't have any past medical history is to give like ibuprofen paracetamol and, you know, have good hydration, good rest and that's how you recover. So that's why the answer here is a, if however, she had a history of asthma, for example, your answer would be um be so a seven day course of amoxicillin. And if they also told us that she has a um uh allergy to uh penicillins, then it would be a Sunday course of doxycycline. Um DNE probably just less likely to be honest because again, it's not gonna be the first thing that you do even if she did have a past medical history. Cool. So moving on to influenza. So influenza, again, it's an acute respiratory tract infection. This time, it's caused by seasonal influenza A or B virus and it's transmitted by inhaling infected respiratory droplets. Um So that's why we call it droplet infection. Um It's a single stranded RNA genome. Um And there's, there's two main antigens that you need to know um on the surface of um an influenza virus. One is H antigen and the other one is the N antigen. So the H antigen kind of simply it's, it's what helps um the virus to enter your cells. So the um tracheo bronchial epithelial cells in the.