COPD

Question 1

What is the oxygen content in bronchitis and effects

Answer 1

Inflammation of airway leads to decresased O2 and cyanosis and hypoxemia = vasoconstriction in lungs = increased pulmonary HTN = R HF and edema

Question 2

What is the oxygen content in emphysema and CO2

Answer 2

Co2 retention, no change in oxygen content no hypoxemia
Increased AP diameter
Prolonged exhalation/ pursed lips (pink puffer)

Question 3

Initial treatment of COPD

Answer 3

SABA + LAMA + LABA + ICS + PDE4 Inhib + steroids

In order

SaLLIPS

Question 4

Treatment of chronic stable COPD

Answer 4

COPDER

Corticosteoids (inhaled if stable, PO if bad, IV if exacerbation)

Oxygen (spo2 want above 88 in 88-92 range so dont lose hypoxic drive)

Prevention: vaccines: flu and strep, smoking cessation

Dilators: short acting (tiotrop, albuteral, LAMA, LABA)

Experimental

Rehab

Question 5

What are the only 2 treatments for chronic COPD that extend life

Answer 5

Oxygen

Smoking cessation

Question 6

Symptoms of exacerabtion of COPD

Answer 6

Wheezing, cough, sputum

Question 7

What tests done in exacerbation of COPD

Answer 7

CXR, ABG, ECG

Question 8

What treatment for exacerbation of COPD

Answer 8

Abx: doxy and azithromyocin

Bronchodilators: albuterol and ipratropium

Steroids (prednisone PO if moderate, mtehylpredinoine IV if bad)

Question 9

How do you know if the COPD treatment has worked

Answer 9

Give O2 at 88-92
Give albuterol and ipratropium q 30 min
Give steroids

If better go home with PO steroids and inhaler
If worse go to ICU and get IV steroids, continuous NEB, Bipap, ET tube
If need more time then go to wards, PO steroids, NEB