PULM Flashcards
asthma triad and hallmarks
triad:
1. airway inflammation
2. airway hyperresponsiveness
3. REVERSIBLE obstruction - seen w/ 12% or more reverse pre vs post BD tx on PFT or 20% or more w/ bronchoprovocation (w/ histamine or methacholine)
* *intermittent symptoms starting at any age (vs COPD more progressive, constant, older w/ hx smoking)
pres - asthma
INTERMITTENT sob, wheezing chest tightness, cough
- symptoms worse at night d/t increased bronchomotor tone b/n 3-4am!
- look for hx of ATOPY or family history of asthma, nasal polyps / mucosal swelling
- most attacks w/in 30 min
diagnosis - asthma
formal dx: PFT - restrictive pattern, 12% or more increase post-BD, increased diffusion capacity
other testing w/ asthma
- in acute exacerbation, use PEAK FLOW to assess airway NOT PFT or spirometry
- mild >300, mod 100-300 and severe <60%!!
- bronchoprovacation done w/ nondiagnostic PFT
- CXR - nl unless severe, use to r/o other lung dz
- ABG: expect respiratory alkalosis w/ increased A-a gradient
- **IF PAC02 IS NORMAL / LOW = sign of IMPENDING FAILURE - MUST INTUBATE (muscles fatigue, RR decreases so PAco2 falls!)
intermittent asthma
sx and SABA 2 or less / week, nighttime awakenings 2 or less/ month
no limitation in activity and PFT nl
STAGE 1 - SABA
persistent mild asthma
sx and SABA >2 / week, awaken 3-4 x mo, 0-1 exacerbations / yr, mild limitation
STAGE 2 - SABA + LOW ICS
persistent mod asthma
sx and SABA daily, awaken >1 / week, 01- exacerbations/ mod limitation
STAGE 3 - LOW ICS + LABA OR MOD ICS
persistent severe asthma
sx and saba >1/d, awaken every night, worsening exacerbations and severely limited
STAGE 4 OR 5 -
4: MOD ICS + SABA
5 HIGH ICE + SABA
*if must move up, add oral corticosteroids
what medication can you not give….
BB CONTRAINDICATED AND DO NOT USE LABA AS MONOTHERAPY - INCREASES MORTALIY!
1st line for persistent asthma?
INHALED CORTICOSTEROIDS
-use MDI + rinse mouth to decrease se (cough, dysphonia, candidiasis)
cromolyn and nedocromil
-mast cell stabalizers and affect eosinophil recruitment - good for preventing sx or for exercise induced but will NOT reduce symptoms already present!
tx mild exacerbation
-inhaled SABA q 3-4 hr x 24-48, may need to increase dose and may need oral corticosteroids (.5-1 mg / kg/d)
tx mod exacerbation
02 (>90%), SABA, systemic corticosteroids
*improvement after 30 minutes correlates w/ severity
tx severe exacerbation (PEF <60%)
*monitor peak flow and paco2!!
oxygen >90%, saba 2.5-5 albuterol q 20 min x 3 - at least 3 in the first hour, systemic corticosteroids IV and then oral
*when you begin to taper systemic, initiate inhaled!
*if not improved, ADMIT!
can add ipratropium to SABA
-mag sulfate - reduces bronchoconstriction
**mucolytic agents, anxiolytics and hypnotics contraindicated!
**response to initial treatment in ED = best predictor for need of hospitalization
what to use for intubation
ketamine or succylnylcholine
