Lung Disease - Quiz 11 Flashcards
Which diseases are considered a part of COPD?
Emphysema
Chronic Bronchitis
Asthmatic Bronchitis
What causes COPD?
Smoking
Occupational/Environmental Exposure
Recurrent Infections
Genetics
What are Symptoms of COPD?
Cough
Dyspnea
Wheezing
What questions should be asked about smoking related to COPD?
Do You Smoke
Have you ever smoked
When did you quit
Packs Per Day
Duration
What should be asked about Dypnea relating to COPD?
Presence
Severity
Exercise Tolerance
Home O2
Baseline SpO2 on RA
What is the FEV1 for High Risk patients?
FEV1 < 2L
What is the FEV1/FVC for High Risk patients?
FEV1/FVC < 0.5
What is the VC for High Risk adults & kids?
Adult: VC < 15cc/kg
Kids: VC < 10cc/kg
or
VC < 40-50% predicted
What are signs of Chronic Bronchitis?
Cough, Sputum, Recurrent infections lasting months to years
Blue Bloaters
Crackles, Wheezes, Peripheral Edema
Caused by Smoking & Occupational Exposure
Who are the Blue Bloaters?
Usually Have Bronchitis
Young, Short, Obese, Fat Neck
OSA & Pickwickian Syndrome
What is Pickwickian Syndrome?
Obesity
Decreased Pulmonary Function
Polycythemia
What are the signs of Emphysema?
Progressive Dyspnea
Minimal Cough
Pink Puffers
Decreased Breath Sounds
What causes Emphysema?
Smoking
Alpha-1 Antitrypsin Deficiency
(Autodigestion of Lungs)
Coal Miners
What happens to the Lungs with Emphysema?
Destruction of Elastic & Collagen Network
Enlarged Air Spaces
Airway Narrow & Collapse during Exhalation
Air Trapping
Who are the Pink Puffers?
Usually have Emphysema w/ Minimal Cough
Thin & Elderly
Pursed Lip Breathers for Auto-Peep & Air Trapping
Hyperinflated & Barrel Chest
What are some complications of Emphysema?
Pneumothorax d/t bullae
Weight loss d/t work of breathing
What are some complications of Chronic Bronchitis?
Polycythemia
Pulmonary HTN
Cor Pulmonale
What are characteristics of Asthmatic Bronchitis?
Episodic Bronchospasm
Chronic Productive Cough
Airway Obstruction
Progression of Asthma
Only Partially Reversible
How much does smoking increase CarboxyHb and the the risks for CAD & Post-Op Lung complications?
CAD: 2x risk
Post Op Lung Problems: 6x risk
COHb: 15% increase
How does Nicotine affect the body?
Stimulates SNS to release catecholamiens –> ↑HR, ↑BP, ↑SVR
Lasts 30 min from last cigg
What steps should be taking for intubating smokers?
Preoxygenate Well
Wait Until Patient is Deep before airway Manipulation
What is the most commonly used Tobacco Product?
E-Ciggs
How long should patients stop smoking before surgery?
12 Hours
Reduce COHb & Nicotine to normal levels
What happens after smoking is stopped for 8 Weeks?
Reduction of Post-Op Lung Problems
What happens after smoking stops for 2 Years?
MI risk will be the same as Non-Smoker
What happens after 2 to 10 days of not smoking?
Decrease in Airway Activity at 2 Days
Same as Nonsmoker at 10 days
How should the vent be managed for COPD patients?
Change I:E to 1:3
Monitor PIP (rupture bullae/bleb)
Keep EtCO2 near baseline
Which drugs should be avoided in COPD patients?
Histamine Releasing Drugs
STP - Pentothal
Morphine
Atracurium
Mivacurium
Neostigmine
Give Nebs b4 extubating
What is Asthma?
Airway Hyper-Reactivity
Bronchial Wall Inflammation
Variably Reversible Airflow Obstruction
What is the PEFP for Moderate & Severe Asthma?
Moderate Asthma: PEFP 40-60%
Severe Asthma: PEFP < 40%
Which population has Increased Asthmas Severity?
Adult Females
What is the Drug of Choice for Induction for Asthma Patients?
Ketamine d/t Bronchodilation, but will incease secretions
Give Robinul
