Pulmonary Flashcards
Asthma Defintion
*Obstructive disease* characterized by an increased responsivenss of the trachea and bronchi to various stimuli
List several Asthma Triggers
- Dust mites
- Pets
- Cockroaches
- Indoor molds
- Exercise
- Cigarette smoke
List several Asthma Signs/Symptoms
**Pulses paradoxus >12 mm Hg (fall of SBP during inspiration)** not a part of other COPD dz’sRespiratory distress at rest
- Difficulty speaking in sentences
- RR >28/min
- HR >110
- Hyperresonance
- Chest tightness
List changes in airways r/t asthma
- widespread narrowing of the airways
- hypertrophy of smooth muscle
- mucosal edema and hyperemia
- thickening of epithelial basement membrane
- hypertrophy of mucous glands
- acute inflammation
- plugging of airways by thick, viscous mucous
Are most allergens indoor or outdoor for asthma pts?
Indoor
What finding is present in the CBC/Diff in asthma pts?
- Slight WBC elevation with eosinophilia
Criteria for intubation in Status Asthmaticus
worsening ABG’s,
decreased O2 sats,
RR>30,
behavioral changes
ABG findings in asthma
Initially resp alkalosis with mild hypoxemia
- pCO2> 45 is emergent
- normal pCO2 (35-45) is a very sick patient
(asthmatics are hyperventilating and CO2 should be low)
List ominous signs of asthma
Ominous signs include
fatigue,
absent breath sounds,
paradoxical chest/abd movement,
inability to mainatain recumbency,
cyanosis (never sign of anything in adult but death)
CXR findings in asthma
Hyperinflation
PFT criteria for asthma
Improvement of FVC or FEV1 of 15% or FEF 25-75 of 25% after inhaled bronchodilator
Examples of:
SABA
Inhaled corticosteroid
LABA
Inhaled-anticholinergic
Anti-leukotriene
Albuterol/proventil, alupent/metoproterenol
Budesonide/Pulmicort, Traimcinolone/Azmacort, “corts”
Salmeterol/Serevent, “erol’s”
Ipatropium bromide/ Atrovent
Monteleukast sodium/Singulair
List meds/ classes for the out-pt tx of Asthma
- Short-Acting B Adrenergic agonist (SABA)(Albuterol/proventil) for symptom relief or before exercise
- Daily maintainence with inhaled corticosteroids“corts” (Budesonide/Pulmicort, Triamcinolone/Azmacort)
- Continue Short-Acting B2 Adrenergic agonist (SABA) for symptom breakthrough
- If symptoms persist, increase inhaled corticosteroid or add Long-Acting B2 Adrenergic agonist (LABA)(Salmeterol/serevent), other options are theophylline or antimediators
- Inhaled anticholinergics (ipatropium bromide/atrovent) if a lot of secretions
- Antileukotrienes (montelukast/singulair) useful for chronic asthma maintainence (long-term stabailization)
4 step med tx of in-pt asthma
- Inhalation sympathomimetics (metoproterenol & albuterol are in the same drug class)
- Corticosteroids in non-responding pts to sympathomimetics
- Parenteral sympathomimetics in pts unable to cooperate
- Anticholinergic
6 steps for out-pt asthma tx
- SABA
- Inhaled corticosteroid
- Add SABA for breakthrough
- LABA
- Anticholinergic
- Anti-leukotriene
Criteria for hospitalization in asthmatics
Initial FEV1 (forced exp. volume = how much air pt can blow out) is <30% of predicted
OR
does not increase to 40% after 1 hr vigorous therapy
Hospitalization recommended if peak flow (max speed of expiration) is <60 LPM OR >50% predicted after 1 hr of tx
Inpatient Management of Asthma
Supplemental O2 2-3 L/min
Mild to mod asthma, ABG not needed if SaO2 >90% by pulse ox
Severe attack, check ABG
Adequate hydration by oral or IV route
Inhalation sympathomimetics:
- Alupent/ metoproterenol (0.3 mL in 5% sol) in 2.2 mL NS q 30-60 min
- Proventil/albuterol, ventolin 0.3 mL in 3 mL NSS q 30-60 min
Corticosteroids in non-responding pts to sympathomimetics
- Methylprednisolone 60-125mg IV x 1 then 20mg IV Q4-6hrs until attack is broken
Parenteral sympathomimetics in pts unable to cooperate
- Aqueous epi 1:1000 0.1-0.5 mL SQ Q 30-90 min, MR x 4
Anticholinergic (atrovent) MDI 2-6 puffs q 4-6 hrs
Status Asthmaticus
Severe, acute asthma presenting in an unremitting, poorly responsive, life-threatening manner. Clinical findings not reliable indicators of severity of asthma.
8 steps for Status asthmaticus managment
(1-5 meds)
- O2
- IV D5 1/2 NS
- Inhalation and parenteral simpathomimetics (albuterol, acqueous epi)
- Methylprednisolone 60-125 or hydrocortisone 300 mg IV
- Atrovent
- Continuous pulse ox
- ABG q 10-20 min
- Intubate (falling ABG’s, decreased O2 sats, RR>30, behavioral changes)
Define Chronic Bronchitis and Emphysema
Chronic bronchitis: Excessive secretion of bronchial mucous manifested by productive cough x 3 yrs or more in at least 2 consecutive years
(stocky, younger with thick secretions)
Emphysema: abnormal, permanent enlargement of the alveoli
(thin, emaciated)
*Obstructive*
CXR findings in chronic bronchitis
bulla,
blebs,
hyperinflation,
low, flat diaphragm
Chronic Bronchitis Signs/Symptoms
*Obstructive disease*
- Intermittent mild to mod dyspnea
- Onset after age 35
- Copious, purulent sputum
- Stocky body habitus
- Normal AP chest diameter
- Normal percussion
- Bulla, blebs on CXR
- Hyperinflation on CXR
- Hct increased
- Hypercapnea, hypoxemia on ABG
Emphysema Signs/Symptoms
- Progressive, constant dyspnea
- Onset > age 50
- Mild sputum, clear
- Thin, wasted body habitus
- Increased AP chest diameter
- Hyperressonance on percussion
- HCT WNL
- Total lung capacity increased
*Loss of hypercapneic drive
Air is trapped
What is the mainstay of tx for COPD?
Mainstay of therapy is: inhaled bronchodilators or sympathomimetics (Albuterol/xopenex)