COPD Flashcards
COPD
obstructive, chronic irreversible inflammation of the airways
what disease are involved
emphysema
bronchitis
RF
smoking
Alpha-1-trypsin deficiency
exposure
signs
chronic cough sputum wheeze dyspnoea frequenters URTIs
hyper-resonant on percussion
reduce chest expansion
cor pulmonale
investigations
spirometry
CXR
spirometry findings
reduced FEV1/FVC
the level of FEV1 can determine the severity of COPD
CXR findings
hyper-inflation
flattened diaphragm
bullae
large pulmonary arteries
management
- SABA or SAMA
asthma features present:
- +LABA and ICS
- LABA + LAMA + ICS
no asthma features present:
- +LABA + LAMA + SABA
- LABA + LAMA + ICS
theophiline
smoking cessation
up to date with vaccines
what are asthma features
history of asthma atopy raised eosinophil count variation in FEV1 at least 400ml diurnal variations
exacerbation of COPD
increased breathlessness
coughing more
feel weak
management:
administer starter pack
admit oxygen
ABG to check if they are CO2 retainer (elevated levels of CO2)
admit in a non-invasive way
if CO2 retainer:
use Venturi system and aim for 88-92%
if not CO2 retainer:
use Venturi system and air for 94-98%
what is in a starter pack and when do you know to start it
prednisolone and an antibiotic
start antibiotic is sputum of cough increases in volume and changes colour
what is the most common organisms to cause an infective exacerbation of COPD
haemophillus influenzae
what criteria is needed for long term oxygen therapy
PaO2 <7.3
PaO2 <8 + pulmonary oedema, secondary polycythaemia
palliative care
what is a ‘normal’ ABG for a COPD patient
pH - reduced
PaCO2 - elevated
HCO3 - elevated
what would be seen on bloods
polycythaemia
what would be seen on ECG
P waves
right axis deviation
criteria for FEV1 stages
> 80% - mild
50-79% - moderate
30-40% - severe
<30% - life threatening
what antibiotic is given as prophylaxis and what should be done before giving
azithromycin
ECG and LFT
what vaccinations should be done
one off pneumococcal
annual influenza
indications for non-invasive ventilation
respiratory acidosis of pH 7.25-7.35
hypoxia
what aims for the oxygen stats
normal PCO2 - 94-98%
high PCO2 - 88-92%
what can extremely large bullae mimic
pneumothorax
when would you give non-invasive ventilation
type 2 resp failure
