CH 65, 66 - Asthma, Copd

Question 1

What meds can trigger asthma attacks?

Answer 1

NSAIDs
BBs
ACE-i

Question 2

Repeat albuterol txs can cause what?

Answer 2

HypoK
HypoMag
HypoPO4

Question 3

All asthma pts should receive what?

Answer 3

Supplemental O2 titrated to > 90%

Question 4

Severe asthma IV mag dosing?

Answer 4

2-3 g over 20 minutes
Or
1 g/min if FEV < 25%

Question 5

What is tertbutaline?

SEs?

Dose?

Answer 5

Long acting b-2 agonist

Skeletal m. Tremor and tachycardia

.25mg subQ q 20 minutes

Question 6

What is initial dose of PO steroids for asthma exacerbation?

IV?

Answer 6

60mg prednisone

IV methylpredinsolone 40-80 mg/day divide into 1 or 2 doses

Question 7

What clinical tetras is seen with ASA exacerbated respiratory disease?

Answer 7

Nasal polyps
Eosinophilic sinusitis
Asthma
Sensitivity to COX1 drugs

Question 8

What is the dose of methylprednisolone in severe asthma attacks?

Answer 8

125 mg

Question 9

What is heliox?

How does it work?

Answer 9

60-80% helium and 20-40% O2

Reduces resistance through airways w/non-laminar flow and reduces respiratory muscle work
Inc diffusion of CO2

does NOT dec need for intubation

Question 10

Drug and dose of preferred med for RSI?

Answer 10

Ketamine 1-2 mg/kg

Question 11

What level of PaCO2 should be avoided as a max?

Cerebral blood flow reaches max when?

Answer 11

100 mmHg

120

Question 12

What causes menstrual induced asthma?

Answer 12

falling PG levels

Question 13

What are the RF for sudden death for asthma?

Answer 13

Corticosteroid use
ED/hospital visit in last 30 days 
> 2 hospitalizations for asthma
> 3 ED visits
> 2 beta agonist canisters
ICU or intubation

Question 14

When do you use tertbutaline?

Answer 14

Cannot tolerate/not responding to nebulized meds

Question 15

What is the ddx is pt with suspected COPD?

Answer 15

Cardiogenic pulmonary edema
MI
pericardial effusion
PE!!!
ARDS
bronchiectasis
Pulmonary fibrosis 

Acute PTX !!!

Question 16

PaO2 of 80 is what O2 sat% = ?

60?

110?

50?

Answer 16

95%

91%

97%

85%

Question 17

What is P pulmonale on EKG?

Answer 17

Peaked P waves in leads V2, V3, Vf
low QRS voltage
Poor R wave progression in V1-V6

Question 18

What is the goal SpO2 or PaO2 in COPD pts?

Answer 18

88-92% or PaO2 > 60

Question 19

What vent settings for COPD pt?

Answer 19

FiO2 100%
TV of 6-8 mL/kg
RR 8-10
Assist control mode
Inspiratory flow rate of 80-100 L/min

Question 20

What is the selection criteria for BiPAP?

Answer 20

Mod-severe dyspnea w/accessory muscle use
RR > 25
Mod-severe acidosis (pH < 7.35) and hypercapnia (PaO2 > 45)

Question 21

Tx for COPD exacerbation?

Answer 21

Prednisone 60mg x 1 day or 1x methylprednisolone 125mg
Duonebs
Azithro if healthy, if not then Augmentin or respiratory FQ

Question 22

Frequent COPD exacerbations can be predicted when FEV1 falls below what value?

Answer 22

50%

Question 23

What medicine for epiglottitis?

Answer 23

Ceftriaxone or cefotaxime