1
Q
What are the types of COPD?
A
- Asthma
- Bronchitis
- Emphysema
- Bronchiectasis
- Bronchiolitis
2
Q
What is inflamation of the large airways?
A
bronchitis
3
Q
What are the causes of bronchitis?
A
- smoking
- air pollution
- allergies
- occupational hazards
4
Q
What are the symptoms of bronchitis?
A
- Cough
- Mucus production
- bacterial infection
- Shortness of breath
- Wheezing
- May be cyanotic in severe cases
5
Q
What does this x-ray illustrate?
A
bronchitis
6
Q
How do you treat bronchitis? (4)
A
- Minimize inflammation with short-term steroid therapy.
- Bronchodilators using Albuterol inhalation.
- Hydration
- Antibiotics if a bacterial infection is present.
7
Q
What is the most common lung disease?
A
Emphysema
8
Q
What causes lung destruction of the terminal bronchioles on down to the alveoli?
A
emphysema
9
Q
What does emphysema cause to happen to the airways?
A
Slowly and irreversibly destroys the elastic fibers that hold open the the small airways.
10
Q
What are the causes of emphsema?
A
- Smoking is the most common cause.
- Some of the causes of bronchitis may also lead to emphysema.
11
Q
What are the symptoms of emphysema?
A
Shortness of breath
Impaired ability to exhale
12
Q
What is the treatment for emphysema?
A
- Short acting bronchodilators, both B2 (Albuterol) and anticholinergic (Atrovent)
- Long acting anticholinergic bronchodilators (Spiriva)
- Inhaled corticosteroids usually are combined with long acting bronchodilator (Advair)
- Oral steroids (Prednisone)
- Antibiotics
- Oxygen in end stage
- Lung reduction surgery if patient has large regions of over distention and poorly functioning lung tissue.
13
Q
What is:
- the swelling and mucus build up in the bronchioles due to a virus infection
- seen in children < 2 y/o
- has a seasonal pattern, usually in the fall and spring
A
bronchiolitis
14
Q
What are the symptoms of bronchiolitis?
A
Shortness of breath
Cough
Wheezing
15
Q
What is the treatment for bronchiolitis?
A
Antibiotics to treat recurrent infections
Hydration
Chest physical therapy
Steroid therapy
Bronchodilators
16
Q
What is the:
- Destruction and widening of large airways that become easily collapsible.
- Can begin in early childhood.
A
bronchiectasis
17
Q
What are the causes of bronchiectasis?
A
- Recurrent infections and inflamation
- Cystic Fibrosis causes about ½ the cases
- Tuberculosis can show signs of this as well
18
Q
What are the symptoms of bronchiectasis?
A
- Shortness of breath
- Cyanosis
- Breath odor
- Chronic cough with large amounts of foul smelling sputum
- Finger clubbing
19
Q
What does this image depict?
A
bronchiectasis
20
Q
What does this CXR depict?
A
bronchiectasis
21
Q
What are the treatments for bronchiectasis?
A
- Hydration
- Antibiotics if there is a secondary infection.
- Antiviral drugs such as Rebetol in sever cases.
- If hospitalization is needed, humidified oxygen and IV fluids for hydration.
22
Q
What type of COPD:
decreased airway lumen due to mucus/inflammation
marked decrease in PaO2
marked increase in PaCO2
increased hematocrit
marked cor pulmonale
prognosis is poor
A
chronic bronchitis
23
Q
What type of COPD:
loss of elastic recoil
severe dyspnea
normal hematocrit
good prognosis
A
emphysema
24
Q
Name the branching of the bronchial tree from the trachea:
A
trachea
primary bronchi
secondary bronchi
tertiary bronchi
bronchioles
terminal bronchioles
25
26
27
What are 6 risk factors that predispose patients?
pre-existing pulmonary disease
thoracic or upper abdominal surgery
smoking
obesity
age \> 60
prolonged general anesthesia ( \>3 hours)
28
29
What COPD classification:
normal spirometry
chronic symptoms include cough and sputum production
Stage 0, at risk
30
What COPD classification:
FEV1/FVC \< 70%
FEV1 \>= 80% predicted, with or without chronic symptoms (cough, sputum production)
Stage 1: Mild COPD
31
What COPD classification:
FEV1/FVC \< 70%
50% \< FEV1 \< 80% predicted, with or without chronic symptoms
Stage II: Moderate COPD
32
What COPD classification:
FEV1/FVC \< 70%
30% \<= FEV1 \< 50% predicted, with or without chronic symptoms
Stage III, severe COPD
33
What COPD classification:
FEV1/FVC \< 70%
FEV1 \< 30% predicted or FEV1 \< 50% predicted plus chronic respiratory failure
PaO2 \< 60 mmHg
PCO2 \> 50 mmHg
Stage IV
34
People under 20 y/o tend to have significantly higher rates of survival from COPD, post-bronchodilator treatment. True or false?
false
35
What are the consequences of COPD with respect to the lungs? (4)
* elevated airway resistance and air trapping increase the work of breathing
* V/Q mismatch (respiratory gas exchange impairment)
* increase in residual volume
* increase in total lung capacity
36
What is the most common trigger for COPD? What are others?
Most common--respiratory infections
Other triggers could be allergens, pungent odors such as perfumes, dust, or molds
37
What are pre-operative measures for pts with COPD? (3)
Pts should be optimally prepared prior to elective procedures
Pts should be questioned on recent changes in dyspnea on exertion, sputum, and wheezing
Smoking should be discontinued for at least 6-8 weeks
38
What are preoperative assessments you should consider in a patient with COPD? (10)
* Do they smoke?
* What is their exercise tolerance?
* When was the last time they came to the hospital for their lung disease?
* Do they have a productive cough? Is there a color to the sputum?
* Are they taking medications related to the COPD?
* If so what kind; bronchodilators, steroids, antibiotics.
* Listen to breath sounds. Is there wheezing, diminished.
* Pulmonary function studies if available.
* What is their SpO2 on room air?
* Are they on Oxygen?
39
What are anesthetic considerations when dealing with a pt with COPD? (3)
Is regional anesthesia an option?
No lung function impairment except with lithotomy and lateral decubitus.
High spinal or epidural can effect accessory muscles and produce an ineffective cough and ability to clear secretions
40
Rapid oxygen desaturation with apnea is a problem, so a through preoxygenation at induction is essential. True or false?
true
41
The use of Sevoflurane or Desflurane is preferred because both are rapidly eliminated from the lungs and would minimize ventilatory depression in the early postoperative period. True or false?
true
42
Spontaneous ventilation will optimize lung function. Patients may not tolerate controlled mechanical ventilation well. True or false?
false
Opposite is true--Controlled mechanical ventilation will optimize lung function. Patients may not tolerate spontaneous ventilation without assistance.
43
Large tidal volumes (10-15ml/kg) combined with a slow inspiratory flow will minimize turbulent flow and help maintain optimal ventilation-to perfusion matching. True or false?
true
44
Slow respiratory rates (6-8bpm) provide sufficient time for complete exhalation to occur. True or false?
true
45
With already compromised ventilatory function and possible poor oxygenation. Assessing Po2, PC02 as well as Ph will better help you optimize your anesthetic management.
Thus what should you consider?
placement of an arterial catheter
46
Which pt will have elevated PCO2 levels: bronchitis or emphysema pt?
emphysema pt with PCO2 at 50 vs. 45 for bronchitis pt
47
Which pt will have elevated PO2 levels: bronchitis or emphysema pt?
emphysema pt at 75 vs. 63
These pt can inhale, but cannot exhale effectively.
48
Which pt will have elevated HCO3 levels: bronchitis or emphysema?
Both are elevated however emphysema have more elevated bicarb levels at 32 vs. 30.
Note: Normal range is 22-26.
49
Which pt will have lower SpO2 saturation levels: bronchitis or emphysema pt?
Bronchitis pt has lower SpO2 sat at 90% vs. 94%.
50
How does the capnogram appear for pts with COPD or for pts that are bronchospasming?
51
Identify the following flow volume loops:
52
Deep extubation may be of benefit in the patient has a reactive airway. True or false?
true
53
What is the risk of deep extubation with an pt with a reactive airway?
You risk respiratory insufficiency that you may not have with an awake patient.
54
What do patients with reactive airways (risk of bronchospasm) require during early postop period?
supplemental O2
55
What surguries are COPD patients at increased risk for postop complications like prolonged ventilatory support and pneumonia? (2)
thoracic
upper abdominal
Both of these surgical locations prevent the patient from taking deep breaths and coughing to clear secretions.
56
Oxygen administration is usually needed into the immediate postop period. A ____ flow to maintain a Po2 of between 60-80 mmHg of a Spo2 of 90-95%.
liter
AP Exam 3
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