Asthma/COPD

Question 1

Treatment for moderate to severe asthma attacks should include this class of drugs giver IV or orally.

Answer 1

Systemic glucocorticoids

Question 2

In asthma, ___ compromises the force generating capacity of the diaphragm.

Answer 2

Hyperinflation

Question 3

What are three changes will you see on a CXR in a patient with asthma?

Answer 3

Hyperinflation
Flattened diaphragms
May have infiltrates from infection

Question 4

How do you treat an asthma attack?
First, give ___. Then give a cocktail of ___ and ___. Next, give ___ via IV. Don’t forget ___! Lastly, give ___ via mask. If there’s an infection, give ___. Don’t use ___ because you will cause more autoPEEP and increase FRC.

Answer 4

Oxygen
Albuterol/Atrovent
Intravenous steroids (Solu-medrol)
Don't forget 2mg of Mag sulfate
Heliox via N/R mask
If infection, give antibiotics
Don't use NIV.

Question 5

Beginning settings for an asthma patient:
TV:
Rate:
Keep track of \_\_\_
Consider \_\_\_
Use short \_\_\_ and long \_\_\_

Answer 5

4-6 mL/kg IBW
12-24
Minute ventilation
permissive hypercapnea
Short I times, long E times

Question 6

There are two inhaled anesthetics that have bronchodilation effects. What are they? (Can you at least say the suffix they have in common?)

Answer 6

Isoflurane and sevoflurane

Question 7

What is the most common cause of an AECOPD?

Answer 7

Upper respiratory infection (Viral or bacterial)

Question 8

What CXR findings will you find in a patient with COPD?

Answer 8

Hyperinflation/Flattened diaphragms
Empysematic paranchyma
Infiltrates or air bronchograms if pneumonia is present.

Question 9

When treating a COPD patient, you want to get an SpO2 between ___ and ___.
Initial O2 flow rate should be ___ to ___ L/min. However, if severely hypoxic, raise FiO2 to ___.

Answer 9

90-92%
1-2 L/min
90%

Question 10

To treat AECOPD, the general guidelines include:
1. (A drug for rescue and a drug for maint.)
2. May also add:
3.
4.
5. (If necessary)
6. (If necessary)

Answer 10

1. Albuterol for rescue.
2. May also add Atrovent and tiotropium
3. Oral and inhaled Corticosteroids
4. Antibiotics
5. NIV
6. Intubate/Ventilate

Question 11

What corticosteroids should you consider for AECOPD (not long term)

Answer 11

Methylprednisolone IV
Hydrocortisone IV
Prednisone orally

Question 12

When signs of infection are present in AECOPD, give these drugs (x3)

Answer 12

Pennicillin, Quinolone, cephalosporin

Question 13

Initial settings for AECOPD:
Mode:
Tidal volume:
Flow waveform:

Answer 13

VC
6-8 ml/kg
Decelerating

Question 14

AECOPD patients: When treating, try to use ___ before intubating.

Answer 14

NIV

Question 15

What kind of humidifier should you use with AECOPD?

Answer 15

Heated wick

Question 16

Why shouldn’t you use an HME with AECOPD?

Answer 16

Increased airway resisitance

Question 17

When weaning a COPD’er, ___ may not be a very good indicator of readiness to extubate.
Do a SBT in this mode:
Extubate to ___ as soon as possible.

Answer 17

RSBI
Pressure support
NIV

Question 18

Describe a moderate persistent case of asthma.
___ limitation that occurs every ___.
FEV1 of ___ to ___
And asthma attacks that occur ___ nights per week or ___ per year.

Answer 18

Moderate limitation every day
FEV1 60-80%
Attacks 2+ nights/week or 3+/year

Question 19

What drugs do you prescribe to someone with moderate persistent asthma?

Answer 19

Medium dose ICS and LABA

Question 20

What’s the alternative treatment for moderate persistent asthma?
Medium dose ___ and ___.
Also, ___ and ___.

Answer 20

Medium dose ICS and LTRA, Theophylline, or Zileuton

Question 21

When an asthma patient says, “My albuterol inhaler isn’t working”, consider:

Answer 21

Pt may be having status asthmaticus.

Question 22

In an acute asthma attack, what is the dose & frequency of Albuterol via HHN?

Answer 22

Albuterol 2.5-5 mg q20 min for one hour

Then 2.5-10 mg q1-4 hrs as needed.

Question 23

In an acute asthma attack, what is the dose & frequency of Albuterol via MDI?

Answer 23

Albuterol 4-8 puffs q20 min for one hour

Then 4-8 puffs q1-4 hrs as needed.

Question 24

In an acute asthma attack, what is the dose for continuous Albuterol?

Answer 24

10-15 mg for 1 hour

Question 25

In an initial evaluation of AECOPD, these four tests will be needed.
First, a common assessment tool includes ___.
Then get a ___ to exclude other possible diseases.
Draw blood to test ___, ___, and ___ at the lab
You also need to get an ___.

Answer 25

Pulse ox
CXR to exclude pneumothorax, PE, Pneumonia, and Pleural Effusion
CBC, electrolytes, and glucose
ABG

Question 26

Additional tests done on an AECOPD patient may include ___ to test cardiac rhythm. Also these two lab results.
If the patient does not respond to initial antibiotic therapy, do this test:
These two tests should not be done. The will not be helpful.

Answer 26

EKG
Cardiac troponin 
BNP
Spiral CT or DDimer
Don't get a sputum culture or gram stain.