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Bronchiectasis

Suspect this in any patient with increased ICP, especially if there is fever or increased TLC. It may follow ear, sinus, dental, or periodontal infection; skull fracture; congenital heart disease; endocarditis; bronchiectasis. It may also occur in the absence of systemic signs of inflammation.

Investigations

  • Sputum culture
  • CXR: Cystic shadows, thickened bronchial walls (tramline and ring shadows)
  • HRCT chest
  • Spirometry
  • Bronchoscopy to locate site of haemoptysis, exclude obstruction and obtain samples for culture.
  • Other tests:
    • Serum immunoglobulins
    • Cystic Fibrosis sweat test
    • Aspergillus precipitins or skin-prick test RAST and total IgE.

Treatment

  • Chest physiotherapy
  • Mucolytics
  • Antibiotics:
    • According to culture and sensitivity
    • Pseudomonas will require either oral ciprofloxacin or suitable IV antibiotics
    • long-term antibiotics (may be nebulized), If ≥3 exacerbations a year
  • Bronchodilators (eg nebulized salbutamol)
  • Corticosteroids (eg prednisolone) and itraconazole for Allergic bronchopulmonary aspergillosis (ABPA)
  • Surgery may be indicated in localized disease or to control severe haemoptysis.

Broad complex tachycardia

Ventricular tachycardia (VT) including torsade de pointes, SVT with aberrant conduction, e.g. AF or atrial flutter, with bundle branch block. Pre-excited tachycardias, e.g. AF, atrial flutter, or AV re-entry tachycardia, with underlying WPW.

Burns

The rule of nines: (arm: 9%; front of trunk 18%; head and neck 9%; leg 18%; back of trunk 18%; perineum 1%).

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