Week 11 Lung Diseases

Question 1

Smoking history:

Always ask 2 questions:

Answer 1

Do you smoke?

Have you ever smoked / when did you quit?

Question 2

When questioning about dyspneat:

Answer 2

exercise tolerance,
home O2 requirement,
baseline SpO2 on room air

Question 3

Chronic Bronchitis is associated with ______

and caused by ________

Answer 3

Cough
Sputum production
Recurrent infections

Caused by smoking, occupational hazards

Question 4

Emphysema is associated with

Causes include

Answer 4

Progressive dyspnea

Causes: Smoking, coal miners, alpha-1 antitrypsin deficiency = autodigestion of pulmonary tissue by proteases

Question 5

Asthmatic Bronchitis is a chronic productive cough, episodic bronchospasm, and airway obstruction that is only ____________

Answer 5

partially reversible (some degree of obstruction will always remain)

Question 6

Nicotine stimulates

Answer 6

sympathetic ganglia – catecholamines released from adrenal medulla – increasing HR, BP, and SVR – persists 30 minutes after last cigarette

Question 7

Anesthetic considerations for smokers

Answer 7

Pre-O2 well and avoid instrumentation of airway until deep level of anesthesia

Question 8

Pre-Op smoking cessation:
advise smoking at least ______ hours before surgery
Cessation of smoking greater than _____ weeks will reduce post op complications

Answer 8

12 hours

8 weeks

Question 9

In patients with COPD, to help avoid bronchospasm, avoid ______ releasing drugs

Answer 9

avoid *histamine releasing drugs
Pentothal (STP), Morphine (MSO4), Atracurium, Mivacurium, Neostigmine
Tx with nebulized albuterol especially before extubation

Question 10

Asthma is an airway ______ and bronchial wall ______ and variable degree of ______ airflow obstruction

Answer 10

Airway hyperreactivity, bronchial wall inflammation and variable degrees of reversible airflow obstruction

Question 11

For asthma, ______ is the drug of choice, but you must pretreat with Robinul (glycopyrrolate) due to increased secretions

Answer 11

Ketamine