COPD Q.M Flashcards
What identifies type 1 respiratory failure on ABG?
Low pO2 (<8), with a normal pCO2
Which investigation should be performed before deciding to commence home oxygen therapy?
Arterial blood gas (ABG). Two ABGs should be taken >3weeks apart (but not within 4 weeks of an acute exacerbation of COPD)
How is COPD classified by severity?
Stage 1 Mild FEV1 ≥ 80% predicted
Stage 2 Moderate FEV1 50-79% of predicted
Stage 3 Severe FEV1 30-49% of predicted
Stage 4 Very Severe FEV1 <30% of predicted
What are the different types of pacemakers?
Single chamber and dual chamber pacemakers. Single chambers have one lead into either the right atrium or ventricle. The dual chamber has two leads one into the right ventricle and right atrium.
Which vaccinations should be offered to patients with COPD?
A one-off pneumococcal vaccination and annual influenza vaccinations
Indications for Long Term Oxygen Therapy
Long Term Oxygen Therapy (LTOT): A trial showed that maintaining oxygen above 8kPa for at least 15 hours a day improved mortality rates.
NICE guidelines state that LTOT can be prescribed for patients who:
Have a PaO2 <7.3kPa on two readings more than 3 weeks apart, and are non-smokers (but not absolutely contraindicated in smokers).
Or have a PaO2 of 7.3-8kPa alongside one of the following: nocturnal hypoxia, polycythemia, peripheral oedema and pulmonary hypertension.
LTOT can also be prescribed for patients with terminal illness.
What is the pattern of spirometry in restrictive lung disease?
In a restrictive disorder, the FEV1/FVC ratio will remain the same or may even increase
What are the ECG features seen in right heart strain?
ST depression and T wave inversion in right ventricle leads: V1-V3, and inferior leads: II, III and aVF (III >II)
What are the key features of COPD?
Chronic bronchitis and emphysema
What are the complications of COPD?
Acute exacerbation of COPD whereby a patient may also develop an infection alongside a flare of COPD
Pneumonia
Polycythemia is seen with patients with COPD. It is a secondary absolute polycythemia due to the long-standing hypoxia. This causes an increase in the red blood cell mass.
Type 2 Respiratory Failure which is caused by alveolar hypoventilation. There is hypoxia and hypercapnia present in patients.
Pneumothorax is also a noted complication due to rupture of bulla.
Cor pulmonale can be seen as a complication of long standing COPD. Patients develop signs of right sided heart failure due to raised pulmonary arterial pressure.
Non-pharmacological management of chronic COPD
Stop smoking
Nutritional support
Flu vaccinations
Pulmonary rehabilitation
To which element can doxycycline bind, resulting in its deposition in bone and teeth?
Calcium
What are the ECG changes seen in COPD?
Right axis deviation
Prominent P waves in inferior leads
Inverted P waves in high lateral leads (I, aVL)
Low voltage QRS
Delayed R/S transition in leads V1-V6
P pulmonale
Right ventricular strain pattern
RBBB
Multifocal atrial tachycardia
What are the prerequisites for starting inhaled therapy in a patient with a new diagnosis of COPD?
Smoking cessation advice, offer pneumococcal and influenza vaccines, offer pulmonary rehabilitation, develop a personalised management plan and optimise other co-morbidities
What is a Venturi mask?
An air-entrainment mask that can deliver specific fractions of inspired oxygen depending on which coloured attachment is fitted (blue – 24% O2, white – 28% O2, yellow – 35% O2, red – 40% O2, green – 60% O2)
