COPD

Question 1

COPD two categories

Answer 1

Pink puffers (emphysema)
Chronic bronchitis (blue bloaters) 
Usually share characteristics with asthma

Question 2

Emphysema (pink puffers)

Answer 2

Characterized by an abnormal enlargement of the air spaces distal to terminal bronchioles, and destroys the walls

Question 3

Chronic bronchitis (blue bloaters)

Answer 3

Inflamed and edematous airways filled with secretions; copious respiratory secretions contribute to expiratory obstruction

Question 4

COPD pathology

Answer 4

Increased airway resistance, especially during expiration from bronchospasm and decreased elasticity from edema and secretions, and airway collapse from limited tissue support
V/Q mismatch, hypoxemia, hypoventilation, hypercarbia

Question 5

S&S COPD

Answer 5

Exertional dyspnea (hallmark)
Chronic productive cough, tachypnea, orthopnea, acessory muscle use, pursed lip exhalation, expiratory wheeze with prolonged expiratory phase, coarse crackes (cleared with cough often) hyperexpansion of thorax, diminished lung sounds, cyanosis, clubbed fingers, hypoxic-hypercapnia

Question 6

Exacerbation

Answer 6

75% with acute exacerbations have evidence of viral or bacterial infection

Question 7

Hypoxemia

Answer 7

The most dangerous part of COPD - tachypnea/cardia, HTN, cyanosis, altered LOC

Question 8

Respiratory acidosis

Answer 8

From CO2 increasing and alveolar hypoventilation causing retention

Question 9

NIPPV

Answer 9

CPAP, BiPAP
Recruit new alveoli and keep them open allowing improved gas exchange and decreasing physiologic dead space
Drops tubes by 50%

Question 10

To tube?

Answer 10

Pts can be difficult or impossible to wean off mechanical vent, this should be considered
Consider at altered LOC (unable to follow simple commands)
Decreased respiratory effort due to fatigue
Laryngospasm, dysrhythmias, vomiting to consider

Question 11

NIPPV tips

Answer 11

Warn of hurricane
Get them to take 5 breaths - they should realize benefits by then
Abandon after 5 minutes

Question 12

PEs

Answer 12

Usually result from DVTs in legs arms and pelvis, sometimes jugular or inferior vena cava
Dyspnea unexplained by auscultation
Chest pain with pleuritic (chest pain, worse with deep breath and pinpoint) features
SOMETIMES syncope or seizure

Question 13

TX

Answer 13

LMWH (low mole weight heparin) anticoag for 3 months

Question 14

Three classes of PE

Answer 14

Massive, sub massive, less severe

Question 15

Massive PE

Answer 15

SBP less than 90 for >15 minutes, tx thrombolytics

Question 16

Submassive PE

Answer 16

Near normal BP but with other cardiopulm stress, txx thrombolytic sometimes butt a higher bleeding risk

Question 17

Less severe

Answer 17

Don’t get fibrinolytics