Quiz 4 Flashcards
What is COPD?
preventable/treatable PROGRESSIVE development of airflow limitation that is NOT FULLY REVERSIBLE; usually an exaggerated INFLAMMATORY reaction
What is the principal risk factor for the development of COPD?
smoking (>70 pack years)
What is another risk factor for COPD besides smoking?
alpha 1 antitrypsin deficiency
Is CO2 elevation a concern early on in COPD?
usually no- CO2 is 20x more soluble than O2 and elevation can be offset by increase in MV
What are symptoms of COPD?
cough, sputum production, wheezing, SOB, progressive exercise intolerance
What is affected first in COPD, O2 or CO2?
O2
What are some changes in PFTs that you would see in COPD?
decrease in FEV1/FVC, decrease in FEF25-75%, increased RV and normal to increased FRC and TLC
What CXR findings would you see with COPD?
flattened diaphragm, hyperinflation
What are some differences between chronic bronchitis and emphysema?
chronic bronchitis- inflammation/mucous, blue bloater, CO2 increased, increased Hct, cor pulmonale
emphysema- loss of recoil, severe dyspnea, pink puffer, normal/decreased CO2, decreased diffusion
What are the stages of GOLD spirometry classification of COPD?
I- mild, FEV1 >80% of predicted
II- mod, FEV1 50-80% predicted
III- severe, FEV1 30-50% predicted
IV- very severe, <30% or <50% with chronic resp failure
What are the mainstays of treatment for COPD?
smoking cessation, O2 supplementation if PaO2 <55, Hct >55%, or evidence of cor pulmonale
goal PaO2 60-80 mmHg
What is drug therapy for COPD?
bronchodilators, diuretics, annual vaccinations
What are bullae?
hyper enlarged air spaces distal to terminal bronchioles- complication of emphysema
What are blebs and what should you avoid?
collections of air bubbles within pleura- usually related to mechanical ventilation; nitrous
What can occur in chronic bronchitis as a result of increased catecholamine levels?
increased cardiac output
What are some pre-op findings in COPD that would increase risk of post-op respiratory failure?
FEV1:FVC of <0.5, PaCO2 >50, acute bacterial infection, no smoking cessation, poor exercise tolerance
What are some immediate effects of smoking cessation?
P50 increases, carboxyhemoglobin decreases, sympathomimetic effects of nicotine last 20-30 minutes
What are some intermediate effects of smoking cessation?
improved ciliary function, decreased sputum production, return of normal immune function and hepatic enzyme secretion
When it comes to regional anesthesia, what should you avoid in someone with respiratory complications?
blocks above T6 and interscalene blocks- can worsen respiratory dysfunction
What are some anesthesia considerations for patients with obstructive disease?
volatile anesthetics act as bronchodilators; use smaller concentrations due to increased time to blow it off, use humidification, expect longer induction/emergence, use large TV and slow rate, cautious with narcotics, use LMA/spont breathing when possible
What are some signs that the patient is air trapping?
increased alpha angle on capnography, expiratory flow does not reach baseline before next breath, PEEP measurement
What is asthma?
CHRONIC INFLAMMATORY disorder of airways, airflow obstruction generally reversible either spontaneously or with treatment; bronchial hyperreactivity
What are some important H&P components in patients with asthma?
previous intubations, admission to ICU, 2+ hospitalizations in last year, co-existing disease
What are signs and symptoms of asthma?
wheezing, cough, dyspnea, chest discomfort or tightness, air hunger, eosinophilia
What are some provoking stimuli for asthma?
allergens, drugs (ASA, B antagonists, NSAIDs), resp infections, exercise
What are some theories for underlying causes of asthma?
deficiency of acquired immunity, genetics, abnormal autonomic regulation, exposure to respiratory system irritants
