Asthma/COPD Flashcards
Treatment for moderate to severe asthma attacks should include this class of drugs giver IV or orally.
Systemic glucocorticoids
In asthma, ___ compromises the force generating capacity of the diaphragm.
Hyperinflation
What are three changes will you see on a CXR in a patient with asthma?
Hyperinflation
Flattened diaphragms
May have infiltrates from infection
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.
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.
Beginning settings for an asthma patient: TV: Rate: Keep track of \_\_\_ Consider \_\_\_ Use short \_\_\_ and long \_\_\_
4-6 mL/kg IBW 12-24 Minute ventilation permissive hypercapnea Short I times, long E times
There are two inhaled anesthetics that have bronchodilation effects. What are they? (Can you at least say the suffix they have in common?)
Isoflurane and sevoflurane
What is the most common cause of an AECOPD?
Upper respiratory infection (Viral or bacterial)
What CXR findings will you find in a patient with COPD?
Hyperinflation/Flattened diaphragms
Empysematic paranchyma
Infiltrates or air bronchograms if pneumonia is present.
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 ___.
90-92%
1-2 L/min
90%
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)
- Albuterol for rescue.
- May also add Atrovent and tiotropium
- Oral and inhaled Corticosteroids
- Antibiotics
- NIV
- Intubate/Ventilate
What corticosteroids should you consider for AECOPD (not long term)
Methylprednisolone IV
Hydrocortisone IV
Prednisone orally
When signs of infection are present in AECOPD, give these drugs (x3)
Pennicillin, Quinolone, cephalosporin
Initial settings for AECOPD:
Mode:
Tidal volume:
Flow waveform:
VC
6-8 ml/kg
Decelerating
AECOPD patients: When treating, try to use ___ before intubating.
NIV
What kind of humidifier should you use with AECOPD?
Heated wick
Why shouldn’t you use an HME with AECOPD?
Increased airway resisitance
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.
RSBI
Pressure support
NIV
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.
Moderate limitation every day
FEV1 60-80%
Attacks 2+ nights/week or 3+/year
What drugs do you prescribe to someone with moderate persistent asthma?
Medium dose ICS and LABA
What’s the alternative treatment for moderate persistent asthma?
Medium dose ___ and ___.
Also, ___ and ___.
Medium dose ICS and LTRA, Theophylline, or Zileuton
When an asthma patient says, “My albuterol inhaler isn’t working”, consider:
Pt may be having status asthmaticus.
In an acute asthma attack, what is the dose & frequency of Albuterol via HHN?
Albuterol 2.5-5 mg q20 min for one hour
Then 2.5-10 mg q1-4 hrs as needed.
In an acute asthma attack, what is the dose & frequency of Albuterol via MDI?
Albuterol 4-8 puffs q20 min for one hour
Then 4-8 puffs q1-4 hrs as needed.
In an acute asthma attack, what is the dose for continuous Albuterol?
10-15 mg for 1 hour
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 ___.
Pulse ox
CXR to exclude pneumothorax, PE, Pneumonia, and Pleural Effusion
CBC, electrolytes, and glucose
ABG
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.
EKG Cardiac troponin BNP Spiral CT or DDimer Don't get a sputum culture or gram stain.
