Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Senior - EMED 2 > 9 - COPD > Flashcards

9 - COPD Flashcards

(64 cards)

Start Studying
1
Q

COPD definition?

A

Persistent airflow limitation that is generally progressive and associated w an abnormal inflammatory response to noxious particles or gases

Emphysemia and chronic bronchitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Asthma vs COPD?

A

Asthma is an acute exacerbation

COPD is a CHRONIC disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Bronchitis vs emphysemia?

A

Bronchitis is productive cough x 3 months in 2 yrs

Emphysema is destruction of the bronchioles and alveoli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

COPD and women?

A

COPD is now an equal opportunity disease

COPD in women has doubled in the past few decades and women are now >50% of COPD related deaths

  • girl power!!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Tobacco causes 100% of COPD, if you look at a cigarette you will die

A

I cant make any promises, but only 15% of smokers develop COPD

Any of the lung irritants up your likelihood though

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What happens with chronic compensation of COPD?

A

Loss of elastic recoil, narrowing and collapse of the smaller airways

Mucous stasis and bacterial colonization develop

There is an insidious progression so the process takes decades

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Stages of COPD severity?

A

Mild - FEV1 >80%

Moderate - FEV1 50-79%

Severe - FEV1 30-49%

Very severe - FEV1 <30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Hallmark symptoms of COPD?

A

PROGRESSIVE:

  • dypsnea
  • cough
  • sputum

These may vary day to day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Feeling of impending doom?

A

Not with COPD, thats asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

PE for COPD?

A

Tachypnea
Accessory muscle use
Pursed-lip exhalation

Wheezing
Prolonged expiratory time

Chronic bronchitis
- coarse crackles

Emphysemia

  • expansion of thorax
  • impeded diaphragmatic motion
  • global diminution of breath sounds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

ABG with COPD?

A

Early:

- mild - moderate hypoxemia w/o hypercapnia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

As COPD advances and FEV1 falls below 1L?

A

Hypoxemia becomes more severe

hypercapnea develops

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Clinical signs of COPD?

A

Facial vascular engorgment
- secondary polycythemia

Hypercabia

  • Tremor
  • Somnolence
  • Confusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

WTF if hypercarbia?

A

Aka:

  • hypercapnia
  • CO2 retention

A condition of elevated CO2 in blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

If concomitant L HF exists?

A

The cardiac auscultatory findings may be overshadowed by the pulmonary inflation abnormalities of COPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

The diagnosis of chronic compensasated COPD is confirmed by?

A

Spirometry:
- postbronchodilator FEV1 of <80% predicted
FEV1 <0.7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the best measure of disease progression once the diagnoses is established?

A

The % of FEV1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

CXR?

A

Chronic bronchitis nothing unless:
- bronchiectasis is present

Emphysema shows hyperaeration

  • anteroposterior chest diameter
  • flattened diaphragms
  • increased parenchymal lucency
  • attenuation of pul arterial vascular shadows
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How to distinguish acute HF from COPD?

A

Difficult but:

COPD
- BNP <100 pg/mL

HF

  • BNP >500 pg/mL
  • ECG shows dysrhythmias or ischemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What reduces COPD mortality?

A

Long-term O2 therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Goal of long term O2 therapy?

A

Increase baseline PaO2 >/= 60
Or
Arterial SaO2 to >/= 90 (94 for his test)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Criteria for long term O2 therapy are

A 
PaO2 = 55mmHg
SaO2 = 88%

Or

PaO2 56-59mmHg when
- pulm HTN or cor pulmonale(sustained RVF) or polycythemia is present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Pharmacotherapy provides?

A

Symptomatic relief
Controls exacerbation
Improves QOL
Improves exercise performance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Chronic COPD meds?

A

Inhaled LONG acting B2 agonist

Inhaled corticosteroids when FEV1<50%

Azithromycin daily
- mild global initiation for COLD staging

Respiratory secretions control

  • antihistamines, antitussive, mucolytics, decongestants
  • humidity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Experts dont recommend ___ for all COPD pts because only 20-30% improve
Long-term systemic corticosteroids - they need inhaled corticosteroids
26
What is the only intervention that can reduce the rate of decline in lung function and the mortality from respiratory causes?
These guys need Jesus, JK, well maybe that too (i’m no theologist) but they need to quit smoking
27
Define acute exacerbations of COPD?
Worsening of respiratory symptoms beyone normal day-day variations and are usually triggered by an infection or respiratory irritant
28
What causes acute exacerbations?
75% of the time - viral/bacterial infection triggered - Hypoxia - Cold - B-blockers - Narcotics - Sedative-hypnotics
29
B Blocker vs B agonist?
B blocker - bronchial constriction B agonist - bronchial dilation
30
Why does supplemental O2 help?
Increases blood O2 concentration and can help reverse pulmonary vasoconstriction
31
How do you test for hypoxemia?
ABG Not the SpO2
32
How does the ED manage COPD exacerbations?
- Assess severity of symptoms - Administer controlled O2 - continuous cardiovascular status monitoring - ABG post 20-30 min if SpO2 <90 - - or concern for symptomatic hypercapnia - administer bronchiodilatiors - - b2 agonist or anticholingergics - oral or IV corticosteroids - abx (if needed) - IV methylxanthine (if refractory) - noninvasive mechanical vent - assess comorbids
33
Consider abx for COPD exacerbation if?
Increased sputum volume Change sputum color Fever Suspicion of infection
34
Basic ED eval for COPD exacerbation should include?
Chest radiograph CBC w differential BMP ECG
35
What is the most life-threatening feature of an acute exacerbation?
Hypoxemia (arterial sat <90)
36
Signs of hypoxemia?
``` Tachypnea Tachycardia Systemic HTN Cyanosis Change in mental status ```
37
Increased work of breathing can cause?
CO2 production increase— > Alveolar hypoventilation —> CO2 retention and respiratory acidosis
38
Diagnosis of acute exacerbation of COPD?
Pulse oximetry IDENTIFIES - hypoxemia Capnography IDENTIFIES - hypercarbia DIAGNOSIS comes from ABG
39
ABG diagnoses and...
Clarifies the severity of exacerbation and the probably clinical course
40
respiratory failure is characterized by?
PaO2 <60 or arterial SaO2 <90 On room air
41
Respiratory acidosis is present if?
Pco2 is >45 Normal is 35-45
42
If pH is <7.35
Acute and uncompensated component of respiratory or metabolic acidosis is present
43
Sputum assessment is?
Basically useless - cultures usually contain a mixed flora and dont guide ED abx selection Basically your mouth is a dirty dirty hole and anything that comes out of it cannot be trusted
44
Radiographs for COPD exacerbations?
Radiographic abnormalities are common and can ID causes - pneumonia Or can id alternate diagnosis like acute HF
45
ECG can show?
Ischemia Acute MI Cor pulmonale Dysrhythmias
46
Labs/imaging to consider with acute COPD exacerbation?
Based on clinical findings and suspicions these can be used as appropriate - Theophylline levels - CBC - Electrolytes - B-type natriuretic peptide - D-dimers - CT angiography
47
Goal of tx for exacerbation of COPD?
- Correct tissue oxygenation - Alleviate reversible bronchospasm - Treat underlying cause
48
If they dont respond to standard therapy?
Reevaluation for other potentially life-threatening issues
49
Your pt has low PaO2 or SaO2 so you put them on O2, how long do you wait before reassessing?
20-30 min for improvement to occur
50
If no improvement or resp acidosis develops your pt needs?
Ventilation
51
Meds for acute exacerbation of COPD?
1st line Short acting B2 agonist - albuterol q 30-60 min Anticholinergic - ipitropium
52
Meds for every acute exacerbation of COPD in the ED?
Start: - Albuterol - Ipitropium - Steroids Send home w - z pack Check their - o2 script levels (make sure they are g2g at home)
53
Why steroids?
The use of short course (5-7 days) of systemic steroids improves lung function and hypoxemia and shortens recover time Doesnt affect rate of hospitalizations but does decrease rate or return visits
54
Why z-pac?
The WHO says so Actually it can be azithromycin, doxycycline, amoxicillin - whatever Little evidence regarding the duration of tx, it ranges from 3-14 days
55
If they arent responding to passive o2?
Noninvasive ventilation can be delivered by - nasal mask, - full face mask - mouthpiece
56
Benefits of noninvasive o2?
Patients with respiratory failure who receive noninvasive ventilation have better outcomes in terms of intubation rates, short-term mortality rates, symptomatic improvement, and length of hospitalization
57
Selection criteria for noninvasive ventilation?
``` Acidosis (pH <7.36) Hypercapnea (pco2 >50) O2 deficit (Pao2 <60.Sao2<90) Sever dypsenea w clinical signs like - respiratory muscle fatigue - increased work of breathing ```
58
Exclusion criteria for noninvasive ventilation
``` Respiratory arrest Cardiovascular instability Change in mental High aspiration risk Viscous/copious secretions Facial surgery Craniofacial trauma Nasopharyngeal abnormalities Burns Obesity (extreme) ```
59
Mechanical vent is indicated if?
Evidence of respiratory muscle fatigue Worsening resp acidosis Deteriorating mental Refractory hypoxemia
60
Goal of assisted vent?
Rest ventilatory muscles | Restore adequate gas exchange
61
Adverse events of invasive vent?
Pneumonia Barotrauma Inability to wean from vent
62
Indications for hospital admission
``` Marked increase in intensity - sudden resting dyspnea - inability to walk room - room Significant comorbids Failure to respond to medical management Freq relapse after ED tx Older age Bad home support ```
63
Indications for ICU?
``` Sever dyspnea that fails to respond Respiratory vent failure despite - supp o2 - noninvasive positive pressure Decreasing LOC Hemodynamic instability Presence of comorbids - end organ failure ```
64
When discharging make sure you arrange the following:
1. Supply of home o2 2. Bronchiodilation tx 3. Short course of steroids 4. Follow up appointments (w/in 1 week) Teach them how to use the meds

Senior - EMED 2 (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions