Respiratory Systm. Deterioration

Question 1

Bronchodilators are what?

Answer 1

Inhaled beta agonist and antimuscorinic agents given via pressurised metered dose inhalers with space or jet nebulisation.

Question 2

Example of bronchodilator:

Answer 2

Salbutamol, terbutaline (beta agonists)
Antimuscorinic Agents (ipratropium)

Question 3

Dose of bronchodilator?

Answer 3

Titrated to response, range from hourly to 6hrly.

Question 4

Types of Tx for Acute exacerbations of COPD?

Answer 4

Bronchodilators.
Corticosteroids.
Antibiotics.
Controlled O2 therapy.
Ventilators Assistance.

Question 5

What do corticosteroids do?

Answer 5

Hassan resolution and ⬇️ likelihood of relapse.

Question 6

What corticosteroids do they give?

Answer 6

Prednisolone.

Question 7

How long do corticosteroids get administered for?

Answer 7

2 weeks

Question 8

Why are Abs given to pt with acute exacerbations of COPD?

Answer 8

If sputum is purulent

Question 9

When is O2 indicated with exac. Of COPD?

Answer 9

If pt is hypoxic - sp02 of < 88 - 92%.

Question 10

Exac. Of COPD: O2 dosage?

Answer 10

0-5 - 2 L/min via NP
Or
@24-28% via Venturi Mask

Question 11

Exac. Of COPD: what must you consider when giving O2 to COPD pts?

Answer 11

CO2 retainers - carefully titration of O2 due to increased risk of hypercapnia if O2 dose is too high.

Question 12

Exac. Of COPD: when is ventilatory assistant indicated?

Answer 12

⬆️ hypercapnia.
Acidosis.

Question 13

Acute Asthma: what is cat 1?

Answer 13

Life threatening.

Question 14

Acute Asthma: cat 2?

Answer 14

Moderate.

Question 15

Acute Asthma: cat 3?

Answer 15

Mild.

Question 16

Acute Asthma: physical exhaustion in life threatening asthma?

Answer 16

Yes and decreased level of consciousness.

Question 17

Acute Asthma: resp. Function of cat 1 asthma?

Answer 17

Poor respiratory effort.
Soft or absent breath sounds.

Question 18

Acute Asthma: Cat 1 (severe): RR:

Answer 18

Bradypnoea.

Question 19

Acute Asthma: Cat 1 (severe): talks in?

Answer 19

Single words. Unable to speak.

Question 20

Acute Asthma: Cat 1 (severe): HR?

Answer 20

Cardiac arrhythmia or bradycardia.
Usually presents before cardiac arrest.

Question 21

Acute Asthma: Cat 1 (severe): central cyanosis?

Answer 21

Present.

Question 22

Acute Asthma: Cat 1 (severe): wheeze intensity?

Answer 22

Quiet. Silent.

Question 23

Acute Asthma: Cat 1 (severe): pulse 02:

Answer 23

⬇️ 90%

Question 24

Acute Asthma: Cat 2 (moderate): physical exhaustion:

Answer 24

May be present

Question 25

Acute Asthma: Cat 2 (moderate): resp. Function:

Answer 25

In obvious distress, chest wall movement. Use of accessory muscles.

Question 26

Acute Asthma: Cat 2 (moderate): RR:

Answer 26

⬆️24.

Question 27

Acute Asthma: Cat 2 (moderate): talks in..

Answer 27

Phrases. Unable to complete sentence in 1 breath.

Question 28

Acute Asthma: Cat 2 (moderate): HR?

Answer 28

^ or = 110 bpm.

Question 29

Acute Asthma: Cat 2 (moderate): central cyanosis

Answer 29

May be present

Question 30

Acute Asthma: Cat 2 (moderate): wheeze intensity?

Answer 30

Moderate to loud.

Question 31

Acute Asthma: Cat 2 (moderate): spO2:

Answer 31

90-94%

Question 32

Acute Asthma: Cat 3 (mild): physical exhaustion:

Answer 32

None

Question 33

Acute Asthma: Cat 3 (mild): resp, function:

Answer 33

Some intense WOB

Question 34

Acute Asthma: Cat 3 (mild): RR:

Answer 34

⬇️24

Question 35

Acute Asthma: Cat 3 (mild): talks in..

Answer 35

Normal

Question 36

Acute Asthma: Cat 3 (mild): HR?

Answer 36

⬇️ 110

Question 37

Acute Asthma: Cat 3 (mild): central cyanosis?

Answer 37

None.

Question 38

Acute Asthma: Cat 3 (mild): wheeze:

Answer 38

Variable.

Question 39

Acute Asthma: Cat 3 (mild): spO2.

Answer 39

^ 94%

Question 40

Risk of ARDS?

Answer 40

Pneumonia. Major trauma. Inhalation injury. Pulmonary contusion. Drowning. Aspiration of gastric contents. Non-cardiogenic shock. Pulmonary vasculitis. Drug over dose. Non-pulm. Sepsis Severe burns. Acute lung injury Pancreatitis Reperfusion oedema post lung transplant. ETOH abuse ^ 30 BMI Hypoalbuminemia Chemotherapy DM acidosis (pH 7.35) Tachyponea O2 supplementation.

Question 41

Pathophysiology of ARDS:

Answer 41

Inflammatory response causes disruptions in aveolar function. (Decrease capillary permeability. Causes oedema to form. Decrease compliance Increase pulm. Vascular resistance. Resulting in overall poor gas exchange due to VQ mismatch.

Question 42

Phases of ARDS

Answer 42

Exudate phase. Proliferation phase fibronic phase

Question 43

Where are blood gases taken?

Answer 43

Direct venepuncture of artery

Question 44

Most common site for taking a blood gas

Answer 44

Radial artery

Question 45

Blood gases: what are they measuring?

Answer 45

pH paO2 paCO2 H3O3- (bicarbonate) Base excess

Question 46

Normal pH levels:

Answer 46

7.35 - 7.45

Question 47

Normal paO2 levels:

Answer 47

80-100

Question 48

Normal paCO2 levels:

Answer 48

35 - 45

Question 49

Normal bicarbonate levels:

Answer 49

22-26

Question 50

Normal Base Excess:

Answer 50

-2 to + 2

Question 51

What is base excess?

Answer 51

Indicate the amount of excess or insufficient bicarbonate, in the body and the amount of acid or alcalinity needed to maintain homeostasis.

Question 52

Acute Resp. failure categories?

Answer 52

Type 1 - hypoxemic Type 2 - Hypercapnemic

Question 53

Hypoxaemic Resp. Failure caused by:

Answer 53

Diffusion abnormalities that impending passage of O2 to aveolus and pulmonary circulation.

Question 54

Hypercapnemic resp. Failure is from:

Answer 54

Insufficient spontaneous ventilation from either ⬇️ respiratory drive, ⬆️ workload or conducting airway disorders that limit movement of gas in and out of lungs.

Question 55

What is VQ mismatch?

Answer 55

When lung devices O2 without blood or blood without O2.

Question 56

When does VQ mismatching occur?

Answer 56

Pts with COPD, pneumonia, chronic bronchitis, pulmonary oedema, airway obstruction, pulmonary embolism.

Question 57

2 types of VQ mismatching

Answer 57

Dead space Shunting

Question 58

VQ shunting means:

Answer 58

Poor oxygenation to alveoli but good blood flow.

Question 59

VQ dead space means:

Answer 59

Well oxygenated pt but poor blood flow.