How would you treat a PE if the patient was becoming hypotensive?
(body cannot dissolve the clot quick enough)
streptokinase or tissue plasminogen activator
When does wheezing occur and why?
- Expiration as there is more resistance on expiration
- Due to narrowing of airways so high pitched whistling sound
What is consolidation and why are bronchial breath sounds heard when you auscultate over an area of consolidation?
- When air from the airways is replaced by something else
- As the consolidation conducts sounds from larger airways so heard louder
Why is there creptius over the wound, why does he have a low blood pressure and how would you manage this patient?
- Fracture of the rib
- Increased pressure in the right side so reduced venous return as SVC compression and mechanical shock
- Insert cannula into 2nd ICS mid clavicular line - reliev tension pneuomthorax
What are some lung conditions that cause mediastinal shift to the same side?
- Lobar collapse
- Pulmonary fibrosis
If your're a smoker, what are your chances of dying from tobacco related disease?
If you are a smoker, chances of dying from a tobacco related disease are 1 in 2
Why is knowing about the prevalence of smoking important?
- 14 in 100 smoke
- Tobacco related disease is the single biggest cause of preventable morbidity and mortality
What are some tobacco related diseases?
- Risk of CVS disease
- More likely to get influenza
- Risk of sudden infant death
- Lung cancer
What are the markers of addiction?
How does nicotine cause an addiction on a chemical level?
- Acts on nAchR to stimulate dopamine release so satisfaction
- Chronic nicotine exposure causes AChR to be upregulated, increasing affinity and sensitivity to an agonist
- Drop in nicotine leads to withdrawals
- Takes 6-12 weeks fo receptors to desensitise after last cigarette
What is the speed of nicotine delivery?
What approach should a doctor initially take to try and stop somebody from smoking? (AAA)
Health professional have big impact on a person's decision and low NNT (number needed to treat to prevent one death) so good
What are some pharmacological treatments for a tobacco addiction?
- Long acting patches
- Short acting gum, lozenges, spray
- Champix for 4-12 weeks
Course of tablets which can help to relieve the craving and withdrawal symptoms associated with stopping smoking
What is a harm reduction approach to curing a tobacco addiction?
--> Contain nicotine but not tobacco so still addiction but less harm from tobacco
What are the arguments for and against the use of e-cigarettes as a harm reduction strategy for tobacco addiction?