Pulmonary Tx And Tests Flashcards
How do you tx mild intermittent asthma?
PRN rescue inhaler (albuterol)
How do you diagnose asthma?
ABG - mild hypoxia and resp. Alk
Spirometry: must have 10% decrease in FEV1/FVC ratio
Methacoline challenge test
How do you define mild intermittent asthma?
Less than 2 days a week
Less than 2 nights a month
FEV1 over 80%
How do you define mild persistent asthma?
More than twice a week
More than two nights per month
FEV1 > 80%
How do you treat mild persistent asthma?
Low dose ICS (beclomethasone or prednisone)+ albuterol
What is moderate persistent asthma?
Daily
More than 1 night per week
FEV1 between 60-80
What is the tx for moderate persistent asthma?
Low-medium dose ICS + long acting B2 agonist ( salmeterol)
And albuterol for rescue
What is severe persistent?
Continual
FEV1 is less than 60%
What is the tx for severe persistent?
High dose ICS+ LABA+ albuterol
Possible PO corticosteroids
What is the tx for acute asthma?
Oxygen Ipratropium bromide Systemic corticosteroids B2 agonists Magnesium if severe
What is the treatment for carbon monoxide poisoning?
100% oxygen
When do you incubate a patient with a severe asthma exacerbation?
When pao2 is less than 50 and PCO2 is greater than 50
What is cromolyn useful for?
Prophylaxis for exercise induced asthma
How do you treat cyanide poisoning?
Nitrites to oxidize iron to ferric iron and make methemoglobin which binds cyanide.
Then use thiosulfate to bind this cyanide to form thiocyanate to be excreted by the kidneys.
What is the tx of methemoglobin?
Methylene blue and vit C
What should you do to diagnose bronchiectasis?
High resolution CT - dilated airways and ballooned cysts
What does a CXR show for bronchiectasis?
Peri bronchial cuffing, tram lines, increased pulm vascular marking
What is the tx for bronchiectasis?
Antibiotics
Physiotherapy
Lobectomy or transplant
What is the tx of an acute exacerbation of COPD?
Same as asthma + antibiotics: Oxygen Anticholinergic B2 agonists IV or inhaled corticosteroids Antibiotics
What can be used to tx severe acute exacerbations of COPD?
BiPAP
When should you do a gram stain and sputum culture?
Fever
Infiltrates on CXR
Productive cough
How do you manage COPD long term?
Smoking cessation B2 agonists Anticholinergics (tiotropium) ICS or systemic corticosteroids Give pneumococcal and flu vaccines
When should supplemental oxygen be given for COPD?
When PaO2 is less than 55 SaO2 less than 89% Hematocrit greater than 55% Cor pulmonale Pulmonary HTN Nocturnal hypoxia
What is the diagnostic criteria of chronic bronchitis?
Productive cough for 3 months per year for 2 consecutive years