RESPIRATORY DISORDERS

As an anaesthetics trainee, I obviously have an interest in respiratory disorders of the lungs and airways. In the finals they are the topics of many chronic and acute disease questions and emergency assessments. 

ABCD approach should be used in all cases of respiratory diseases, even if it seems odd. The chronic COPD patient can be evaluated by looking at their co-morbidities, airway issues, breathing issues, circulatory issues, disability and everything else.

You will give yourself leverage with which to talk about in the examinations.

Common respiratory diseases include:

• Asthma
• COPD
• Bronchiectasis/Empyema
• Pneumonia and infective issues
• Restrictive Lung Diseases - Fibrosis, Industrial Disease
• Lung Cancer
• Childhood Issues - Croop, Laryngeal Malacia, Stridor
• Stridor and acute obstruction of the airway
• Pleural disease - effusions, plaques etc
• Pulmonary hypertension (it's VERY good to know this - even though it's fairly post graduate - think about how it relates to right atrial burden)

Treatment/Investigation issues include:

• Airway assessment in the ABCD approach
• Inhaled steroids and bronchodilators like beclomethasone and salbutamol; can you tell me the asthma treatment ladder?
• Theophylline/Aminophylline etc
• Antibiotics - regimes and escalation
• Nebulisers - nebulised adrenaline, salbutamol, salmeterol, ipratropium bromide - regimes/back-to-back nebulisers/oxygen driven v air driven
• IV/PO steroids like hydrocortisone and prednisalone (what is the difference?)
• Airway adjuncts like Guedel and Nasopharyngeal Airways
• Non Invasive Ventilation - NIPPY/NIV/CPAP to get rid of hypercapnia
• Hypercapnia/Hypoxia
• ABG
• Chest Xrays
• Mucolytics like mucodyne (carbocisteine)
• Pulmonary Function Testing
• Bronchoscopy
• CT Chest
• LIGHT'S CRITERIA for pleural effusions (click here)

You should also know about cystic fibrosis and its pathophysiology, treatment plan, screening in parents and implications for the patient.