Respiratory

Question 1

What are the most common triggers of Asthma Exacerbation - 5

Answer 1

1. URI
2. Exercise
3. Cold air
4. Allergens
5. Psychosocial stress

Question 2

List the 9 main causes of SOB

Answer 2

I CoughCCAAPPP

Interstitial Lung Disease

CHF

Cancer Lung

COPD (wheezing + Prolonged expiration)

Asthma (wheezing + Prolonged expiration)

Acute Coronary Syndrome (Unstable**Angina/StableAngina/AcuteMI)

PE

PNA

PTX

Question 3

When should you consider rapid sequence induction and intubation in asthma exacerbation pts - 3

Answer 3

≥1 of 3 is present

1. B2 agonist does NOT reverse sx
2. Significant hypoxia despite supplemental O2
3. Pt Too tired to continue breathing on their own

This is actually RARE for asthmatics to needs this

Question 4

List important historical components for asthma exacerbation - 6

Answer 4

1. # previous episodes
2. # previous ED visits/hospitalizations/ICU admissions
3. Steroid use
4. ever need intubation?
5. # inhalers used / day
6. baseline Peak expiratory flow rate

Be sure to note any accessory muscle usage

Question 5

How much O2 should asthamatics ALWAYS be placed on, regardless of severity of breathing

Answer 5

6-8 L/min with goal of O2 > 92%

Question 6

A severe Asthma exacerbation pt has been given O2 and Duonebs without any improvement

What’s next step in management? - 3

Answer 6

Either

1. Epi 0.2mg IM q20 min x ≥3
2. Terbutaline 0.25mg subQ
3. Mg 2g IV over 20 min IF SEVERE ASTHMA EXACERBATION

additionally, consider obtaining ABG and measure Theophylline if necessary

Question 7

What is the 3 Criteria for COPD Exacerbation

Answer 7

1. SOB
2. ⬆︎Cough
3. Sputum ∆

Question 8

Tx for COPD Exacerbation-4

Which improves survival? Which ⬇︎future events?

Answer 8

“I’m having COPD Exacerbation! Give me DOPA! (but not really)”

1. Duoneb/Combivent (albuterol + ipratropium)
2. O2 PRN via BiPAP (goal: 90-94% O2 Sat)
3. [Prednisone 40 mg qd x 5] (can take up to 24 hrs to work)
4. Abx (Azithro-⬇︎future events vs Levoflox vs Doxy)

Question 9

For asthma exacerbation pts, when are PFTs obtained in the ED - 2

Answer 9

1. On arrival
2. After each Duoneb tx

Question 10

How is asthma exacerbations stratified in terms of severity? - 4

Answer 10

Mild = > 70% of predicted or personal Peak expiratory flow rate = can be d/c home after tx

Moderate = 40-69%

SEVERE = < 40%

DEFINITE ICU = < 25% and doesn’t improve by ≥10% with tx

Give them DOPE

Question 11

Tx for Asthma Exacerbation-4

Answer 11

“I’m having an Asthma Exacerbation! Give me DOPE! (but not really)”

1. Duoneb/Combivent (albuterol + ipratropium)
2. O2 PRN via BiPAP (goal: 90-94% O2 Sat)
3. [Prednisone 40mg qd x 7] (can take up to 24 hrs to work)
4. Epinephrine (or Terbutaline 0.25mg) 0.2mg IM IF REFRACTORY TO O2

Question 12

What are the main side effects of albuterol - 3

Answer 12

1. Tachycardia
2. Tremor
3. mild hypOkalemia