Respiratory Diseases Obstructive

Question 1

Upper respiratory tract infections for anesthesia?
ASA recommends with URI that you wait __ weeks?
% infectious and % allergic?

Answer 1

• anticipate secretions, premie, reactive airway from second hand
• 6 weeks if URI
• 95% infectious, 5% allergic

Question 2

In adult with a common cold, wait at least ___ weeks?
Considerations for these patients?
Lookout for?

Answer 2

• 2 weeks.
• Hydrate, anticholinergic to reduce secretions, limit -airway manipulations, +/- bronchodilators.
• Bronchospasm, laryngospasm, wheezing, obstruction, croup, desats, atelectasis.

Question 3

Fev1

FeF 25-75%, Maximum midexp flow MMEF

Answer 3

• % of vital compacity of air in the first second that you can blow out ( if 50% need to maximize)
• average expiratory flow over the middle half of the FC

Question 4

VC equation (f/m)

Answer 4

(21. 78 - .101(age in yrs)) x height in cm

27. 63-.112a X h

Question 5

Obstructive vs Restrictive???
(Lung recoil = or < or > CW recoil)
FRC up or down?

Answer 5

Obstructive: lung recoil < CW recoil, FRC increase
Restrictive: CW recoil < lung recoil, FRC decrease

Question 6

Questions to ask about asthma

Answer 6

Fev1 less than 35%? Cough during night? Wheezing even with drugs?

Question 7

Low Fev1? Low MMEF?

Answer 7

Fev1 35% & MMEF<20%

Question 8

Asthma triggers in anesthesia

Answer 8

Muscle relaxants, morphine (histamine), stress, infections, allergens

Question 9

CXR for asthma

Answer 9

increased bronchial wall markings, flattening diaphragm, hyperinflation, patchy infiltrates

Question 10

Leukotriene Modifiers

Answer 10

daily use for asthmatics. long term control and prevention of asthma symptoms

Question 11

Big gun for asthma

Answer 11

Terbutaline ( also used in premie labor) .25 mg in the lateral deltoid (NOOOO IV)

used in premie labor to stop premature labor. relaxes uterus

Question 12

Status Asthmaticus

Answer 12

Does not respond to routine treatment, considered life threatening.

• give B2 agonists & keep saturated with 02 since its hard to keep sat over 90%
• magnesium sulfate esp in kids

Question 13

Eosinophil count

Answer 13

Blood test that measures the white blood cells

normal: <500

Question 14

asthmatic bronchospasms % risk

Answer 14

4% so regional if possible

Question 15

Does ketamine increase secretions?

Answer 15

yes use anticholinergics with dan says`

Question 16

asthma i/e ratio

Answer 16

1:3 is cool

Question 17

Asthma why consider deep extubation?

Answer 17

surgery not for full stomach but had to bc laparoscopy. you keep posion on for deep

Question 18

What monitoring tool for intraop bronchospasms?

Answer 18

esophageal stethoscope

Question 19

The primary symptom of COPD

Answer 19

expiratory wheezing

Question 20

Emphysema vs chronic bronchitis drive for breathing:

Answer 20

capnia vs hypoxic drive

Question 21

pink puffer

Answer 21

emphysema, bulla barrel chest,

Question 22

blue bloaters

Answer 22

excessive mucus, increase CO, v/q mismatch, polycyemia

Question 23

chronic bronchitis number defining

Answer 23

cough and sputum 3 months in each of 2 successive years

Question 24

why keep COPD at 20-30% oxygen? what to treat hypoxia?

Answer 24

oxygen sensitive and develop type II respiratory failure? 95/94% o2??

Question 25

how much peep with pneuothroax

Answer 25

none

Question 26

Preop cessation for ___ hours is enough to shift p50 towards normal in pt who smoke one to two packed of cigs per day

Answer 26

12

Question 27

How long does hypoxic pulmonary vasoconstriction take effect? Inhibition of this hypoxic pulmonary vasoconstriction?

Answer 27

30 minutes to vasoconstrict the under ventilated areas | iso or sevo for double lumen tube

Question 28

Hypoxic pulmonary vasoconstriction functions best between __-__% of lung hypoxia?

Answer 28

30-70%

Question 29

Where is the dermatome for regional? 10 dermatome or below

Answer 29

10 dermatome or below | (around belly button), inability to cough, lower extremities use, but must be able to lay flat,

Question 30

Interscalene block complication with asthmatics?

Answer 30

resultant phrenic nerve palsy

Question 31

Bronchiectasis

Answer 31

a chronic condition where the walls of the bronchi are thickened from inflammation and infection. People with bronchiectasis have periodic flare-ups of breathing difficulties, called exacerbations.

Question 32

Cystic fibrosis

Answer 32

- sweat chloride test | - Bronchodilator therapy, aerosolized medications, dornase breaks down DNA in the sputum, abx therapy