1
Q
COPD meds
A
- Saba - Albuterol, Xopenex, Ipratropium bromide
- Laba- Salmeterol, spiriva
- Steroids for inflammation - Fluticasone, budesonide
- MDI - Advair, Symbicort
2
Q
COPD
hospital management for exacerbagtion
A
- meds: SABA and antibiotics
- oxygen - 24 -28% for hypoxemian
- NPPV (pH <7.35 and Paco2 >45)
- INtubate (pH <7.30 and Paco2 >50)
3
Q
COPD
When do you intuate?
A
pH is , 7.30 and Paco2 >50
for pts with acute hypercapnic resp. failure and server hypoxemia
4
Q
Short- acting beta agonis
A
Albuterol, Xopenex, Ipratropium bromide
5
Q
Long acting beta agonist
A
Salmetero,
Arformoterol (Brovana) ,
Formotetol. (Perforomist)
6
Q
Emphysema / c. Bronchitis
Patient assesment
apperance
A
barrel chest, increased A-P diameter, clubbing and cyanosis
7
Q
Ephysema / C. Bronchitis
COPD breath sounds
A
diminished aeration with bilateral expiratory wheeze
8
Q
Ephysema / Chronic Bronchitis
chest percussion
A
Percussion : tympanic or hyperresonant
9
Q
Emphysema / Chronic Bronchitis
Pulmonary funtion testing
A
decreased flows (FEV1, FEV1/FVC, FEFn25-75)
10
Q
Terminology used to describe COPD
A
Chronic ventilatory failure, increased lung compliance, chronic hypercapnia, loss of elastic recoil, Chronic CO2 retention
11
Q
Treatment for C.Bronchitis
(Or Emphysema)
A
- low o2 spo2 is 88-92%
- aerosolized bronchodilators (SABA, LABA, anticholinergic, LAMA)
- bronchial hygiene as indicated
- inhaled corticosteroids
- antibiotics if indicated by sputum culture
- smoking cessation / nicotine therapy
- pulmonary rehabilitation
*consider NPPV for acute exacerbation - proper nutrition
*education programs
12
Q
Asthma
Patient assessment : Appearance of the chest and Resp pattern:
A
Chest: increased A-P diameter during episode
RP: accessory muscle usage, retractions
13
Q
Asthma severity PEFR or FEV1
A
Mild > 80%
Moderate 60-70%
Severe <60
14
Q
med given for status asthmaticus
A
Bronchodilator- Albuterol , Levalbuterol
Anticholinergics - Ipratropium
Corticosteroids- hydrocortisone, methylprednisolone
- Severe - magnesium sulfate or epinephrine
15
Q
Asthma medications
SABA
A
albuterol, Xopenex, Ipratropium
16
Q
Asthma medications
Corticosteroids for inflamation
A
prednisone
methylprednisolone
17
Q
Asthma Assessment
Resp. pattern
Chest percussion
A
RP: accessory muscle use, retractions (in children)
CP: Hyperresonant / tympanic note
18
Q
Asthma assessment
breath sounds
A
- Diffuse wheezing
- diminished
- prolonged expiration
19
Q
asthma assesment
physical appearance
A
Diaphoresis
20
Q
Asthma assessment
Vital signs
A
- Tachycardia
- tachypnea
- pulsus paradoxus
21
Q
Astham chest x-ray
A
- increased A-P diameter
- translucent lungs fields
- depressed/ flattened diaphragms
22
Q
Asthma post-bronchodilator spirometry
A
- Post-bronchodialator: considered a significant response if FEV1 increases at least 12% and 200mL
23
Q
Asthma management of acute episodes
A
- O2
- SABA and anticholinergic agents
- Corticosteroids
- intubate if ventilatory failure or resp. arrest occurs
- considere: heliox, magnesium sulfate, subcutaneous epinephrine
24
Q
Asthma Long term control
A
control meds:
* LABA
* inhaled corticosteroids
* mast cell stabilizers
* leukotrine inhibitos
Asthma action plan
25
Green
Asthma cation plan
| Peak Flow ?
Action plan?
Stable
Peak Flow 80 -100 %
| continue with med in daily treatment plan , use Preventative medicine
26
Yellow
Peak flow and asthma action plan
increase in symptoms
Peak Flow 50-80%
* Give Preventative (anti-inflammatory) inhalor
* ADD: quick relief inhalor (albuterol)
* begin / increase oral steroids
* call doctor
* return to level 1 when symptos improve
27
Red
asthma action plan
| peak flow?
no improvement after increasing treatment after yellow zone
Peak flow <50%
* Quick relief bronchodilator inhaler
* Begin/ increase treatment with oral steroids
* call doctor!
28
Assess severity of asthma with __ or __
PEFR or FEV1
Mild >80 %
Moderate 60-70%
Severe <60%
29
Asthma Medications
| In Hospital (SABA & corticosteroids etc.
* SABA - Albutero, Xopenex, Ipratropium
* Corticosteroids - Prednisone, methylprednisolone
* oxygen for hypoxdemia
| After 3 nebs of albuterol, if wheezing continues give corticosteroids
30
Asthma medication
(home care, rehab)
| ICS, SABA, LABA, MDI
* Inhaled corticosteroids - Fluticasone, Pulmicort, Azmacort, Singulair
* Albuterol
* LABA - seravent, only use with ICS
* MDI - Advair, Symbicort
31
Bronchiectasis
| definition
Chronic dilation and distortion of one or more bronchi as a result of excessive inflammation and destruction on bronchial walls, blood vessels, elastic tissue, and smooth muscle
32
Bronchiectasis
| Patient assessment
* hx of pulmonary infections and cystic fibrosis
* cyanosis, barrel chest, clubbing
* Tachypnea, dyspnea, accessory muscle use
33
Bronchiectaisis
| Diagnostic chest percussion and cough
CP: Hyperresonant or tympanic
Cough: Pruductive of purulent, fouls smellin secretions , hemoptysis, sputum separete into 3 layers
34
Bronchiectasis treatment
* oxygen therapy
* bronchopulmonary hygiene
* Lung expansion therapy
* Antibiotics
* expectorants
* aeroslized SABA and anticholinergic
35
Cystic Fibrosis
An inherited, genetic disorder involving the exocrine glands. Results in thick viscous mucus accumulation in the lungs and prohibits enzymes from reaching the intestines leading to inhibition of digestion of protein and fat and deficencies of Vitamins A,D,E and K.
36
CF
breath sounds
diminished, crackles, wheezing
37
CF
general appearance
Barrel chest, cyanosis, clubing, small for age, malnutrition, poor body development, peripheral edema
38
CF
Respiratory pattern
Rp: tachypnea, dyspnea on exertion, use of accessory muscles of inspiration and expiration, cough productive of large amount of thick purulent secretions
39
past medical hx: Positive family hx, mecomium ileus as newborn, recurrent respiratory infections, failure to thrive
CF
40
CF
x-ray
-Translucent (dark) lung fields,
-depressed or flattened diaphragm,
-right ventricular enlargement,
-areas of atelectasis and fibrosis.
41
Cystic Fibrosis
CBC
elevated Hb and Hct concentration.
42
Cystic Fibrosis
sputum culture
Opften positive for *Staphylococcus aureus, Haemophilius influenza, Pseudomonas aeroginosa*
43
Cystic Fibrosis
Special test
* New born - screening by immunoreactive trypsin level (IRT)
* Sweat Chloride Test (>60 mEq/L)
* Genetic testing of CFTR mutation
44
Positive CF Sweat Chloride test
> 60mEq/L
45
Cystic Fibrosis
mediactions
* Bronchodilators
* Expectorants for mobilizing secretions
* Mucolytics - Pulmozyme
* Antibiotics for infection (TOBI)
* CFTR modulators (Orkambi, Symdeko, Kalydeco)
46
How frequently do you give TOBI for CF
nebulized twice a day every other month to reduce bronchiectic exacerbations.
47
Do you use NPPV for CF?
Why?
Yes, for impending ventilatory failure (pH<7.30)
48
Treatment for CF
* Chest percussion and postural drainage
* Exercise
* PEP therapy
* High Frequency chest wall compression
* O2 therapy
49
Inhaled antibiotics
| 3
* Tobramycin (TOBI)
* Colistin
* Amikacin
50
name a mucolytic for CF
dornase alpha (Pulmozyme)
51
Apnea is diagnosed in pt who..
have more than 5 episodes of apnea per hour that may occur in REM and/or non-REM sleep over a 6 hour period
52
Hypopnea
shallow or slow breathing
53
Central sleep apnea
Caused by…
caused by failure of the respiratory center of the brain to send signals to the reps. muscles
54
In Polysomnography, If both nasal flow and resp effort decrease then desaturation decreases its called?
| CSA or OSA
Central Sleep Apnea
55
Polysomnography: If nasal flow decreases with an increase in respiratory effort then desaturation, then its is called?
| CSA or OSA
Obstructive sleep apnea
56
Definition: the average number of apneas and hypopneas per hour of sleep
AHI
| apnea-hypopnea index
57
Normal AHI
| apnea-hypopnea index
<5 episodes/ hour
58
AHI
* Mild
* Mod
* Severfe
* mild 5-15
* mod 16-30
* Severe >30
59
Treatment for Central sleep apnea
NPPV
60
Treatment for Obstructive apena
* nasal CPAP
* weight loss
* sleep posture (lateral or upright)
* oxygen therapy
* surgery (UPPP, trach)
* oral appliances
* neck collar
61
Chest Trauma / Flail Chest
| General apperance & Resp pattern
GA: Anxious, cyanosis, bruising over area
RP: shallow, rapid respirations, paradoxical chest movement (flail chest)
62
Diagnostic chest precussion for flail chest/ chest trauma
May have sign and symptosm of penumothorax ( hyperresonant/ tympanic note)
63
Chest Trauma / Flail Chest
Breath Sounds
diminished breath sounds over affected area
64
Treatment for MILD Chest Trauma / Flail Chest
| Mild
* Mild - Pain medication, lung expansion therapy and bronchial hygiene (IS and deep breathing and coughing, IPPV)
65
Pneumothorax
General assessment
Possible diaphoresis, cyanosis, tracheal or mediastinal shift away from the affected side, bruising over affected area
66
Pneumothorax
Resp. pattern
Tachypnea reduced movement on affected side
67
Pneumothorax
* Breath sounds
* Chest percussion
* BS: diminished or absent on affected side
* CP: Hyperresonant/ tympanic note over affected side
68
Pneumothorax
Vital signs
Tachycardia, pulsus paradoxus, hypertension
69
Pneumothorax
Chest X-ray
Hyperlucency with absence of vascular markings on the affected side, tracheal shift to the unaffected side, depressed diaphragm, lung collapse
70
Treatment for Pneumothorax less than 20% of lung collapse
may only require bed rest and limited physical activity
| absorption occurs withing 30 days
71
Treatment for Pneumothorax greater than 20% lung collapse
should be evacuated by chest tube or needle if patient is unstable ( bradycardia, hypotension, cyanosis)
* Give Hyperinflation therapy (IS/SMI, IPPV) after chest tube insertion
72
Hemothorax
general appearance
* Cyanosis,
* tracheal or mediastinal shift away from the affected side
73
Hemothorax
* Resp. patterns & cough
* Breath sounds
* RP: tachypnea, productive cough (hemoptysis)
* BS: diminished or absent on affected side
74
Treatment for Hemothorax
* thoracentesis or chest tune
* Hyperinfaltion therapy (IS,/SMI, IPPB)
* mechanical ventilation
75
Carbon monoxide poisoning is present when...
COHb > 20%
76
Carbon Monoxide Poisoning
General appearance
* Anxious
* surface burns
* singed facial hair
* black spot marks
* Cyanosis or cherry red color
77
Carbon Monoxide Poisoning
Breath sounds
Normal in early stages, may present with wheezing, crackles or rhonchi inspiratory Stridor
78
PFT of Carbon Monoxide Poisoning
Decreased volumes and flowrates (Vt,VC,FEV...)
* decreased DLco
79
Treatment of Carbon Monoxide Poisoning
* marked or severe distress/ stridor - intubate
* Oxygen therapy 100%
* Hyperbaric oxygen therapy - for severe poisoning
* Mechanica ventialtion for ventilatory failure
* Pulmonary hygiene
* Hyperinflation therapy
80
Carbon Monoxide Poisoning
aerosolized Medication
* Bronchodilators ( Albuterol , Xopenex)
* Mucolytics and expectorants
* Corticosteroids
* Analgesics for pain
* Antibiotics for infection
81
In Carbon Monoxide Poisoning use ___ to diagnose burn injury to upper airway
bronchoscopy
82
Congestive Heart Failure
Def.
Abnormal condition that reflects impaired cardiac pumping. Caused by myocardial infarction, Ischemic heart disease or cardiomyopathy
83
Pulmonary Edema
Excessive movement of fluid from the pulmonary vascular system to the extravascular system and air spaces of the lungs (alveoli). Most commonly caused by CHF
84
Most common cause of Pulmonary Edema
CHF
85
CHF / P. Edema
general appearance
Peripheral / pedal edema
Diaphoresis
Cyanosis
86
CHF / P. Edema
Respiratory Pattern
Tachypnea, orthopnea, paroxysmal nocturnal dyspnea
| orthopnea - elevate at 30 -35 degrees so they can breath
87
CHF / P. Edema
cough
cough: pink frothy secretions
88
CHF / P. Edema
Chest x-ray
* bilateral fluffy opacities
* dilated pulm. arteries
* Left ventricular hypertrophy (cardiomegaly)
* butterflu or bat wing pattern
* Kerley A&B lines
89
CHF / P. Edema
PFT
reduced volumes and capacities
* Normal FEV1/FVC ratio
90
CHF / P. Edema
* hemodynamics
* cardiac enzymes
* Hemo: Increased PCWP, PAP
* CE: elevated brain natriuretic peeptide (BNP)
91
Positive inotropic agents
for CHF
digitalis, digoxin docutamine, dopamine
92
Analgesic
for CHF
* Analgesic - morphine (slow down breathing)
93
Preload reduction agents for CHF?
| and pulmonary edema
nitroglycering, nitroprusside, morphine
94
Antidysrhythmic agents for CHF / P. edema
Bradycardia : atropine
Tachycardia : procainamide, metoprolol
95
Arrhythmias etiology
Hopoxemia
Ischemia
Electrolyte imbalance
conduction disorders
96
List a few medications for CHF
* Digitalis - to increase muscle contractility
* Lasix to promote fluid excretion
* Nipride (vasodialtor) increase flow
97
Do you give lasix for small or mild edema ?
no
98
Left heart failure
Associated with:
pulmonary edema
99
right heart failure
peripheral edema
100
Meds for P. edema
* Digitalis / dobutamine to increase cardiac output
* Lasix for fluid excretion
* Vasodilators - morphine and Nipride to decrease vascular resistance and improve cardiac output
| If diuretics dont work, intubate and MV for acute ventilatory failure
101
treatment for Premature Ventricular Contraction
| PVC
Treat with oxygen, lidocaine and consider causes
102
Treatment for Ventricular fibrillation ?
defibrillation
103
For Atrial flutter, fibrillation and ventricular tachycardia WITH pulse consider ...
synchronized cardioversion
104
What is a frequen complication of COPD and interstitial lung disease
Pulmonary hypertension
105
An increase in mean pulmonary artery pressure greater than 25mmHg at rest.
Pulmonary Hypertension
106
Pulm. Hypertension
general appearance
anxious
diaphoretic
cyanotic
peripheral edema
jugular venous distension
107
Pulm. Hypertension
Resp. pattern
* RP : dispnea, shortness of breath during routine activity tachypnea
108
Pulm. Hypertension
* breath sounds
* cough
* wheezing
crackles
pleural friction rub
* cough : non-pruductive
109
Pulm. Hypertension
Chest x-ray
underluing lung disease
enlarged pulmonary arteries
110
Hemodynamics for Pulm. Hypertension
increased PAP
111
treatment for Pulm. Hypertension
* Diuretics to reduce fluid buildup
* Blood thining meds
* Inotropic agents (digitalis)
* Warfarin (Coumadin)
* O2 therapy
* nitric oxide for severe cases
112
Pulm. Hypertension
blood thining medications
1. Apixaban (Eliquis)
2. Fondaparinux (Arixtra)
3. Heparin (Levenox)
4. Rivaroxaban (Xarelto)
5. Warfarin (Coumadin)
113
Interruption of coronary blood flow for an extended period of time causing potentially irreversile damage to the heart muscle, potentially leading to sudden cardiac arrest
Myocardial Ischemia / Infarction
114
Myocardial Ischemia / Infarction
* general appearance
diaphoretic,
anxious
c/o chest pain
possible cyanosis
115
Myocardial Ischemia / Infarction
*Diagnostic testing*
* ABG
* Electrolytes
* electrocardiogram
* Cardiac enzynes
* ABG: Hypoxemia
* Electrolytes: Hyperkalemia or hypokalemia
* Electrocardiogram: inverted T waves, elevated S-T segment
* Cardiac enzymes: Elevated troponin level
116
Electrocardiogram for Myocardial Ishemia
Inverted T waves, elevated S-T segment
117
treatment for Myocardial Ischemia / Infarction
* 100% oxygen (priority)
* Aspirin
* Morphine
* Anti-arrhythnmic agents as indicated (amiodarone, Procainamide, atropine)
* Nitrates for chest pain
* Maintain blood pressure with fluids or vasopressors (dopamine)
* Defibrillate for pulseless ventricular tachycardia or venticular fibrillation
118
Causes of Blood clots developing in peripheral blood vessels
* Venous stasis ( inactivity, prolonged bed rest or sitting)
* Fat/ air emboli
* Trauma, fractures
* recent surgery
* Obesity
* Pregnancy / child birth
119
Pulmonary Embolism
general appearance
* Anxious
* diaphoretic
* cyanotic
* cool or clammy skin
120
Pulmonary Embolism
respiratory pattern
shortness of breath, tachypnea
121
Pulmonary Embolism
Breath sound:
cough:
BS: wheezing, crackles, pleural friction rub
cough: Possible hemoptysis
122
Pulmonary Embolism
chest x-ray
increased density in infarcted area, dilation of pulmonary arteries, wedge-shaped infiltrate
123
Pulmonary Embolism
Hmodynamics
increase PAP
124
Pulmonary Embolism
Capnography
PECO2 : decreasing PECO2 with normal PaCO2
125
Pulmonary Embolism
Vd/Vt ratio
| decrease or increased?
increased
126
Pulmonary Embolism
Prevention
* Anticoagulants ( heparin )
* Anti-embolisn (compression) stockings
* Pneumatic compression device
* Early ambulation
127
Pulmonary Embolism
management / treatment
* Oxygen therapy ( PaO2 >80 torr )
* Anticoagulants ( Heparin )
* Analgesics to relieve chest pain
* Digitalis , digoxin to maintan circulation
* Thrombolytic agent - urokinase, strephtokinase, tPA
128
Thrombolytic agents for PE
urokinase, streptokinase, tPA
129
consist of right ventricular enlargement (hypertrophy, dilation or both) and is secondary to pulmonary hypertension from disorders of the chest wall or lungs
Cor Pulmonare
130
increased right ventricular workload as a result of pulmonary hypertension causing hypertrophy of the right ventricle. Often caused by COPD
Cor Pulmonale
131
Cor Pulmonale
physical appearance
distended neck veins, chest pain, peripheral edema
132
Cor Pulmonale
appearance of the chest
increased AP diameter with obstructive lung disease
133
Cor Pulmonale
hemodynamics
increased CVP, decreased QT with exercise
134
Chronic disorder of the neuromuscular junction that interferes with chemical transmission of acetylcholine
Myasthenia Gravis
| Moves from Mind to Ground
135
Myasthenia Gravis
general appearance
general weakness that improves with rest, drooping eyelids (ptosis), double vision (diplopia), difficulty swallowing (dysphagia)
136
drooping eyelids
ptosis
137
Different term for double vision
diplopia
138
dysphagia
difficulty swallowing
139
Myasthenia Gravis
* respiratory pattern
* Breath sounds
Rp: shallow breathing
Bs: diminished with crackles
140
Special test for Myasthenia Gravis
* Edophonium Test (Tensilon challenge test)
* electromyography (muscles test movement)
* Blood test for Ach receptor antibodies
141
If Vt,Vc MIP and weakness improve with Tensilon its reffered as ?
Myasthenic Crisis - more of this type of drug needs to be given
* Maintenance drug therapy (anticholinesterase therapy, cholinesterase imhibitors ) including Pyridostigmine (Mestinon, Regonol ) and Prostigmine (Neostigmine)
142
what is a maintenance drug thearapy for Myasthenia Gravis
* anticholinesterase therapy
cholinesterase Including : Pyridostigmine (Mestinon, Regonol)
and Prostigmine (Neostigmine)
143
If Vt, VC, MIP and weakness worsen with Tensilon, its referred as ?
Cholinergic Crisis - overdose of anticholinesterase drugs
* Administer Atropine to reverse Tensilon
144
rare autoimmune disorder that causes inflammation and deterioration of the patient's peripheral nervous system
| Ground to Brain
Guillain-Barre Syndrome
145
Guillain-Barre Syndrome physical appearance
Acute weakness, especially in the legs, cyanosis
146
Guillain-Barre Syndrome
Resp. pattern
shallow breathing
147
Guillain-Barre Syndrome spontaneous vent parameters
decreasing Vt, Vc, MIP
148
Chronic bronchitis cough assessment
cough: congested, productive or thick sputum
149
Guillain-Barre Syndrome
Arterial Blood Gas watch for ...
ventilatory failure
PaCO2 >45 torr
150
Guillain-Barre Syndrome
Lumbar puncture measures:
high protein level CSF (>500mg/dL)
CSF - cerebrospinal fluid
151
Guillain-Barre Syndrome
Special Test
* Lumbar puncture
* abnormal electromyography
* elevated IgM levels
152
Guillain-Barre Syndrome
general management
* monitor and stabilzation of vitals
* monitor SpO2, VC and MIP
* Frequent ABG measurement (when there's a spirographic change)
* hyperinflation therapy (IS, IPPB)
* mechanical ventilation for impending or acute vent. failure
153
what type of therapy is effective with Guillain-Barre Syndrome
Plasmapheresis and intravenous immunoglobulin (IVIG) therapy
154
Drug Overdose
patient assessment
* slow, shallow breathing
* diminish breath sounds
* altered level of consciousness, euphoria
155
Drug Overdose
treatment/ management
1. airway maintenance
2. MV for ventilatory failure
3. Reversal agents
* Naloxone (Narcan ) - for narcotics
* Flumazenil (Romazicon) - for benzos
* Acetlycystein - for acetaminophen
156
reverse agent for narcotic overdose
Naloxone (Narcan)
157
reversal agen for benzodiazepine overdose
Flumazenil (Romazicon)
158
reversal agents for acetaminophen
Acetylcysteine
159
Stroke / acute brain attack
patent assessment
| Cerebrovascular accident (CVA)
* motor and speech loss
* bradypnea, cheyne- Stokes respiraotions
* Hypertension, fever
160
Stroke / acute brain attack
Medica history
* cebrebral thrombi or emboli
* atherosclerosis
* hypertension
* transient ischemic attacks
161
Stroke / acute brain attack
Diagnotic testing
* CT/MRI
* cerebral angiogram
* intracranial pressure monitoring - may be elevated
162
Stroke / acute brain attack
drug therapy
* Anticoagulation therapy
* Vasodilators
* Thrombolytic therapy: tissue plasminogen factor (tPA)
163
Stroke / acute brain attack
Management
* Drug therapy
- anticoagulants
- vasodilators
- thrombolitic therapy (for acute ischemic stroke): tissue plasminogen factor (tPA)
* Mechanical ventilation (hyperventilation may be helpful to reduce ICP)
| avoid use of PEEP
Treatment should be initiated within 6 hours of symptoms
164
For a Stroke / acute brain attack what do you avoid during MV?
PEEP (b/c it increases ICP)
165
What can help reduce ICP during MV?
| intracranial pressure
Hyperventilation
166
An acute illness or injury to the lungs that results in reduced lung compliance, diffuse atelectasis and refractory hypoxemia
Acute Respiratory Distress Syndrome (ARDS)
167
ARDS etiology
* sepsis (most common cause)
* Aspiration
* Pneumonia
* Severe trauma
* Massive blood transfusion
* drug abuse
168
ARDS
breath sounds
| Acute Respiratory Distress Syndrome
bronchial, crackles
169
ARDS
respiratory pattern
tachypnea,
substernal or intercostal retractions
170
ARDS
* general appearance
* vital signs
* cyanotic
* tachycardia, hypertension
171
ARDS
chest percussion
Falt / dull note
172
ARDS
chest x-ray
* increased opacity
* diffuse alveolar inflitrates with honeycomb or ground glass
173
# chest x-ray
* diffused alveolar infiltrates with a honeycomb or graound glass appearance
ARDS
174
Acute Respiratory Distress Syndrome
Pulmonary function
Decreased volumes and capacities
| Vt, RV, FRC and TLC
175
ARDS
hemodynamics
elevated PAP with normal PCWP
176
ARDS
Treatment / management
* treat underlying cause
* O2 therapy
* CPAP / PEEP (treat refractory hypoxemia)
* monitor hemodynamics
* hyperinfaltion therapy (SMI/IS, IPPB) for atelectais
* Mechanical ventilaton
177
ARDS
vent. settings
| as indicated
1. VT 4-6mL/kg
2. plateau pressur < 30 cmH2O
3. initiate recruitment maneuvers
4. maintain PaO2 >55
178
ARDS
Other alternative approaches to MV
1. inverse ratio ventilation (IRV)
2. Pressure Regulated Ventilation (APRV)
3. Pressure REgulatated Voulume (PRVC)
4. High Frequency Ventilation (HFV)
5. Permissive hypercapnia
179
Consider __ position to improve oxygenation for ARDS
Prone position
180
use inhaled nitric oxided (iNO) to treat ...
pulmonary artery pressure
181
An infectious inflammatory process that primarily affects the gas exchange area of the lung causing capillary fluid to pur into the alveoli.
Infectious disease / Pneumonia
182
This process leads to inflammation of the alveoli, alveolar consolidation and atelectasis
Infectious disease / Pneumonia
183
Infectious disease / Pneumonia
| Past medical hx
initially mimics a cold or flu, signs and symptoms may develop quickly, may have chest pain
184
Infectious disease / Pneumonia
patient assessment
* SOB (may be present)
* productive cough - yellow/green sputum
* decreased chest expansion, increased tactile and vocal fremitus
* cyanosis
* Diaphoretic
185
Infectious disease / Pneumonia
chest percussion
Flat or dull note
186
Infectious disease / Pneumonia
breath sounds
Crackles, bronchial, whispered pectoriloquy
187
Infectious disease / Pneumonia
vital signs
increased HR, BP,QT, temperature
188
Infectious disease / Pneumonia
chest x-ray
increased density from consolidation and atelectasis, air bronchograms , possible pleural effusion
189
Infectious disease / Pneumonia
CBC
increased WBC with bacterial infection,
decreased WBC with viral infection
190
Infectious disease / Pneumonia
special test
* CT scan
* Acid fast stain for tuberculosis
* ELISA test for HIV
191
ELISA test is done to detect ...
HIV
192
Infectious disease / Pneumonia
Treatment / management
* oxygen therapy
* pulmonary hygiene therapy
* Hyperinfaltion therapy
* Mechanical ventilation
* VAP protocol for intubated pt
* drug therapy ( antibiotics, antipyretics, analgesics, cough suppressants )
* thoracentesis for pleural effusion
193
Drug therapy for Infectious disease / Pneumonia
* Antibiotics
* Antipyretics (control fever)
* Analgesics (pain)
194
Immunocompropmise medical conditions can be cuased by ?
HIV
cancer
diabetes,
malnutrition
certain genetic disorders
195
signs and symptos of Immunocompropmise
* Frequent and recurrent pneumonia, bronchitis, sinus infections, ear infections, meningitis or skin infections
* inflammation and infection of interna organs
* blood disorders (low platelet count or anemia)
196
Pneumocystis carinii/ jirovecii infections can be treated with..
aerosolized pentamidine
197
Failure of the cardiovascular system to adequately perfuse tissues that results in widespread impairment of cellular metabolism; a reduction in blood flow to the tissues that is inadequate to sustain life.
Shock
198
# Types / causes of Shock
Cardiogenic
| cause?
heart failure
199
# Types / causes of Shock
Neurogenic or Vasogenic
| cause?
Alterations in vascular smooth muscle tone
200
# Types / causes of Shock
Anaphylactic
| cause?
Hypersensitivity / allergic reaction
201
# Types / causes of Shock
Septic
| cause?
Infection
202
# Types / causes of Shock
Hypovolemic
| cause?
Insuffiencent intravascular fluid volume
203
# Types / causes of Shock
Traumatic
| cause?
Components of hypovolemc and septic shock
204
# Patient assessment
Shock
general appearance
Pale or cyanotic
cold
clammy
lethargic
unresponsive
diaphoretic
poor capillary refill
205
# patient assessment
shock
res. pattern
Tachypnea, shortness of breath
206
Shock
| hemodynamics
decreased CVP, PAP, PCWP, QT
207
Shock
dianostic testing
| ABG?
Hemo?
Urin output
* ABG : hypoxemia
* Hemo : decreased CVP, PAP, PCWP, Qt
* urine output : decreased
208
Shock
Treatment/ management
* mechanica ventilation fro vent failure
* Vasopressors for wasogenic shock (dopamine, dobutamine)
* Inotropic agents for heart filure (digitalis, dogoxin
* Antibiotics for infection
* Treat hypovolemia with IV fluids
209
Vasopressors for vasogenic shock
dopamine
dobutamine
210
# Shock
Inotropic agents for heart fialure
digitalis
digoxin
211
treat hypovolemia with ..?
IV fluids
212
a medical specialty which deals with the cause, prevention and treatment of obesity
| BMI >30 kg/m2
Bariatrics
213
common risk of obes pt :
* difficult to proved ventilation via manual resuscitation bag
* difficult intubation (bull neck - mallampati >3)
* Atelectasis
* hemodynamic instability
* DVT and pulmonary embolism
214
# Bariatric condiation s
Obstructive sleep apnea is prevalent leading to :
* Obesity Hypoventilation Syndrome / Pickwickian Syndrome
* Compensated respiratory acidosis
* Cor pulmonale
215
# Bariatric condiations
guidelines for mechanical ventilation
1. Vt at 6mL/kg of IBW
2. PEEP, helful to offset weight of chest wall
3. Elevated head of bed to prevent aspiration and VAP
4. Early extubation if on CPAP
216
surgical removal of the larynx
Laryngectomy
217
Laryngectomy
treatment / management
* use meticulous suctioning technique
* watch fro bleeding / clots
* Cool aerosol will help keep secretions thin in the ealry post-op period
* Monitor basic laboratory test
218
Head Trauma / Surgery
etiology
* Traumatic brain injury
* Tumors
* Aneurysms
* Cerebrovascular accidents
* Seizures
219
Head Trauma / Surgery
Resp. pattern
irregular rhythm, Cheyne-Stokes or Biot's breathing
220
Head Trauma / Surgery
Patient assessment
| RR, level of consciousness, and pupillary response
1. Resp.rate irregular, Cheyne - Stokes or Biot's breathing
2. Level of consciousness: altered level of consciousness (increased risk of aspiration
3. pupillary response: abnormal
221
Head Trauma / Surgery
treatment
* airway protection
* O2 therapy - maintain PaO2 100 torr
* MV (minimize mean airway pressure, low PEEP and pip
* Benzo or propofol for sedation
* Treat acute ICP >20mmHg ( heperventilation, hob elevated, Mannitol )
* Dilantin for seizures
222
Intracranial pressure
5-10 mmHg
223
how to treat acute elveations in ICP ?
| >20 mmHg
* hyperventilation
* keep head of bed elevated
* Mannitol
224
use dilantin for
seizures
225
decreased renal function secondary to diabetes mellitus or renal insufficiency
Diabetes / renal failure
226
Diabetes / renal failure
resp. pattern
may exhibit Kussmaul breathing
227
Diabetes / renal failure
physical appearance
Alert
lethargic
confused
comatose
unresponsive
pedal edema
228
Diabetes / renal failure
secondary assessment
| ABG, urine output, blood glucose level
* abg: metabolic acidosis
* urine ouput: decreased (<500mL/day)
* blood glucose level: >160 mg (diabetic)
229
Diabetes / renal failure
primary assessment
| hx, Resp.pattern, BS, appearance
* hx: diabetes mellitus, renal disease
* Resp. pattern: may exhibit Kussmaul breathing
* BS: rales if CHF is present
* appearance : alert,lethargic, confused, comatose, unresponsive, pedal edema
230
Hypothermia
hx:
appearance :
* hx: near drowning or cold exposure, indigent, homeless or elderly persons
* app: shivering, confusedm poor coordiantion, cyanosis, peripheral vasoconstriction
231
Hypothermia
vital signs
decreased HR,RR Qt, temperature
232
If pt has a temp < 37, how would their ABG actual values differ?
| PH, PCO2, PO2
* pH - increased
* Pco2 - decreased
* PO2 - decreased
233
Near drowning
assessment
| cough, color, Resp pattern
* cough - frothy pink stable bubbles
* cyanosis
* BS- crackles and rhonchi
234
Near drowning
* physical appearance
* vital signs
* Pa - confused, unconscious, comatose
* VS- increased HR, BP, Qt, hypothermia
235
Near drowning
Chest x ray
initially can be normal, fluffly infiltrates, pulmonary edema
236
Near drowning
treatment / management
* 100% oxygen
* Intubate with PEEP
* Inotropic agent
* Diuretics
* Warming
* ECMO for severe cases
237
If neck injury is suspected after near drowning, you should?
intubaate with flexible bronchoscope
238
what type of bronchoscope do you use to intubate someone that has neck injury?
felxible bronchoscope
239
# PEDIATRIC DISEASES
Asthma
(Reversible Airway Obstruction)
clinical presentation/ mdiagnosis
dyspnea
cough
increased production of secretions
accessory muscle use
increased respiratory rate
and expiratory wheezing
240
# PEDIATRIC DISEASES
Asthma
(Reversible Airway Obstruction)
Children may complain of ..?
stomach ache
241
Asthma
(Reversible Airway Obstruction)
chest x-ray
may show hyperinflation, flattened diaphragms and infiltrates
242
# PEDIATRIC DISEASES
Asthma
(Reversible Airway Obstruction)
improved air movement in the lungs
| auscultation
decreased bs (silent chest) and then increased wheezing indicates improved air movement
243
Asthma
(Reversible Airway Obstruction)
Helpful diagnostic test
* Pulmonary function testing (spirometry)
* Exhaled nitric oxide testing helpful in monitoring airway inflammation
* Bronchoprovocation challenges with methacholine or exercise
244
# PEDIATRIC DISEASES
Asthma
(Reversible Airway Obstruction)
control medications
1. LABA: salmeterol, formoterol, argormeterol
2. Inhaled corticosteroids: beclomethasone, budesonide, fluticasone
3. Leukotriene modifiers: motelukast, zileuton
4. Immunomodulators: Omalizumab, palivizumab
245
# Asthma
(Reversible Airway Obstruction)
LABA control medication
* Salmeterol
* formoterol
* arfomoterol
246
# Asthma
(Reversible Airway Obstruction)
Inhaled corticosteroids
* beclomethasone
* budesonide
* fluticasone
247
# Asthma
(Reversible Airway Obstruction)
Leukotriene modifiers
* omalizumab
* zileuton
248
# Asthma
(Reversible Airway Obstruction)
Immunomodulators
omalizumab
palivizumab
249
# PEDIATRIC DISEASES
Asthma
(Reversible Airway Obstruction)
Quick relief medication
* SABA :albuterol, levalnuterol
* Anticholinergics : ipratropium
* Systemic corticosteroids: prednisone, methylprednisolone
250
# PEDIATRIC DISEASES
Asthma
(Reversible Airway Obstruction)
EMERGENCY ROOM CARE
* start with O2
* Inhaled SABA agents : 3 treatments/hour
* Inhaled anticholinergics
* systemic corticosteroids
251
acute episode that fails to respond to usual bronchodilator treatment
Status asthmaticus
252
# PEDIATRIC DISEASES
Asthma
(Reversible Airway Obstruction)
ADDITIONAL TREATMETN
* continuous aerosol bronchodilator
* subcutaneous epinephrine
* intravenous steroids
* Magnesium sulfate
* He/O2 therapy
* inhaled anesthetics (isoflurane, sevoflurane, halothane)
253
# Asthma
recommend comprehensive astham management program which includes
* patient and parent education
* identification and avoidance/ management of triggers
* peak flow monitoring
* recognizing signs and symptoms of episodes
* Asthma action plan
254
most common type of Pediatric Pneumonia?
Viral Pneumonia
255
most common cause of viral pneumonia
Respiratory suncytial virus
256
other causes of infectious disease / pediatric Pneumonia
Parainfluenza Virust type 1,2,3
Influenza cirus
Adenovirus
Enterovirus
Coronavirus
257
___ is also responsible for the majority of cases of bronchiolitis in young children
Respiratory Syncytial Virus (RSV)
258
treated with aerosolized ribavirin (Virazole) administered by small paritcle aerosol generator (SPAG)
Respiratory Syncytial Virus (RSV)
259
# pediatric diseases
Risk factors of baterial pneumonia
* Immunocompromise
* aspiration from GERD
* malnutrition
260
cause agens of baterial pneumonia in neo pt
Group B *streptococcus, Escherichita coli*
261
causative agens of bacterial pneumonia in pediatric pt.
*staphylococcus pneumoniae
H influenza
S aureus *
262
# pediatric disease
aided by blood cultures and elevated band count (>1500 toal bands )
diagnosis for bacterial pneumonia
263
# Peds
an inflammatory process that cuases edema and swelling of the mucous membranes jus below the vocal cords (subglottic area) resulting in airway obstruction.
Croup (Laryngotrachobronchitis)
264
Primarily a viral infection, most often cause by Parainfluenza viruses or RSV transmitted by aerosol droplets
croup
265
Past medical hx : recent cold that developed gradually into a barking cough over 2-3 days
| more often in the fall and winter
croup
| Laryngotracheobronchitis
266
Croup
patient assessment
Cough
characteristic barking cough, stridor, hoarse voice
267
croup
physical appearance
* cyanosis
* alert with some accessory muscle use
* nasal flaring
* rhinorrhea
268
Croup
resp. pattern and Breath sounds
RR: tachypnea , substerna and intercostal retrations
BS: diminished with inspiratory stridor
269
Croup
vital signs
* increased HR, BP, LOW GRADE FEVER
270
# chest x-ray
Haziness in the subglottic area, steeple sign , pencil point, picket fence, hour galss narrowing of the upper airway
Croup
| laryngotracheobronchitis
271
croup MILD case treatment
* temperature control - cool
* adequate hydration and humidification of insp. air
* close monitor:
* oxygen therapy 30-40%
* cool aerosol mist (face mask)
* drug therapy: racemic epi, corticosteroids
272
Croup:
if child does not respond to cool aerosol or racemic epi then give ____
corticosteroids
273
MicroNefrin
Vaponefrin
| is also called?
racemic epinephrine
274
Croup SEVERE cases treatment
* intubation (lethargic, severe stridor, diminished breath sounds)
* temp control - cool envirtoment
* adequate hydration and humidification of inspired air
*
275
croup : criteria for intubation
1. Lethargic, exhausted
2. Severe stridor at rest
3. Diminished breath sounds
4. Extreme accessory muscle usage
276
Bacterail infection caused by *Haemophilus infleinza B* transmitted by aerosol droplets
| gram negative bacteria
epiglottitis
277
Life threatening emergency caused by inflammation of the suprglottic region that causes swelling just above the cocal coreds
epiglottitis
278
past medical hx : sudden onset withing 6-8 hours
cough: mufflend cough
epiglottitis
279
epiglottitis
physical appearance
* 2-6 years of age,
* pale or cyanotic,
* lifeless,
* drooling, hoarsenss,
* difficulty swallowing (dysphagia) ,
* tongue thrusts forward during inspiration,
* voice and cry muffled,
* jaw jutted forward
280
*2-6 years of age, pale or cyanotic, lifeless, drooling, hoarsenss, difficulty swallowing (dysphagia) , tongue thrusts forward during inspiration, voice and cry muffled, jaw jutted forward
epiglottitis
281
epiglottitis
resp. pattern
* tachypnea
* nasal flaring
* substernal and intercostal retractions
282
epiglottitis
Breath sounds
diminished with inspiratory stridor
283
epiglottitis
vital signs
increased hr, bp, HIGH grade fever
284
# chest x-ray
Latera: haziness in the supraglottic area (epiglottis), supraglottic swelling or THUMB SIGN
Epiglottitis
285
Emphysema / c. Bronchitis
Respiratory . Pattern
* resp. pattern: dyspnea, accessory muscle use, pursed-lip breathing
286
CBC for Epiglottitis
elevated WBC
287
Epiglottitis treatment
* Immediate placement of an artificial airway
* sedate
* T-piece or CPAP
* O2 therapy
* Drug therapy - antibiotics
288
# PEDS
The most serious defects create ___, resulting in severe hypoxdemia
right -to-left shunting
289
# PEDS
name 2 congenital heart defects
1. Tetralogy of Fallot - overriding aorta, pulmonary stenosis, ventricular septal defect, and right ventricular hypertrophy
2. Tranposition of the Great Vessels - aorta is switched with pulmonary artery
290
# Congenital Heart defects
overriding aorta, pulmonary stenosis, ventricular septal defect, and righ ventricular hypetrophy
Tetralogy of Fallot
291
# congenital heart defects
aorta is switched with pulmonay artery ( aorta arises from the right ventricule and the pulmnoanry artery arises from the left venticle)
Transposition of the Great Vessels
292
congenital heart defects
patient assessment
* Cyanotic
* RR: Tachypnea
* Auscultation : normal bs, loud heart murmur
293
# congenital heart defects
Transposition of the Great Vessels heart shape ?
egg -shapped heart
294
# congenital heart defects
Tetralog of Fallot heart shape?
Boot - shaped heart
295
# PEDS
what is the most importan diagnostic test to identify cardiac defects ?
Echocardiogram
296
# congenital heart defects : blood gas study
if the pre-ductal (right radial artery) PO2 is > 15torr higher than the post-ductal (umbilical artery) PO2 thenthe pt has ...
right - to - left shunt
297
# congenital heart defects:
how to place trancutaneous monitors to evaluate pre and post ductal blood gas
one placed on the upper right thorax (pre-ductal) and the other on the lower left thigh or left abdominal region (post-ductal)
298
congenital heart defects treatment/ management
* O2 therapy -maintain PaO2 levels between 50-80 torr
* mechanical ventilation for vent failure
* prostaglandis to maintain patent ductus arteriosus
* supportive care prior to surgical correction
299
Asthma PFT test
* reduced flowrates (peak flow, FEV1, FEV1/FVC)
300
A chronic, inflammatory, obstructive, non-contagious airway disease with varying levels of severity, characterized by exacerbations of wheezing and coughing
Asthma
301
Asthma patient assessment: shortness of breath
pused-lip breathing, chest tightness
302
Asthma Pulmonary Function: Bronchial Provocation Test will show
FEV1 decreases significantly when a provocative agen, such as methachoine, is inhaled
303
An inherited, genetic disorder involving the exocrine glands. Results in thick viscous mucus accumulation in the lungs and prohibits enzymes from reaching the intestines leading to inhibition of digestion of protein and fat and deficencies of Vitamins A,D,E and K.
Cystic Fibrosis
304
caused by insufficient amount of pulmonary surfactant or depressed surfactant activity that leads to massive atelectasis and hypoxemia
Infant Respiratory Distress Syndrome (IRDS)
Hyaline Membrane Disease (HMD)
305
past med hx:
* Gestational age < 38 weeks,
* low APGAR scores,
* signs of resp distress present at birth or within a few hours after delivery
* L:S ration < 2.1
Infant Respiratory Distress Syndrome (IRDS)
Hyaline Membrane Disease (HMD)
306
Infant Respiratory Distress Syndrome (IRDS)
Hyaline Membrane Disease (HMD)
| general appearance
Cyanosis
307
Infant Respiratory Distress Syndrome (IRDS)
Hyaline Membrane Disease (HMD)
| Respiratory pattern
* Tachypnea and possible apnea
* intercostal retractions
* nasal flaring
* grunting
308
Infant Respiratory Distress Syndrome (IRDS)
Hyaline Membrane Disease (HMD)
| breath sounds
bronchial or harsh,
fine crackles/rales,
expiraotry grunting
309
Infant Respiratory Distress Syndrome (IRDS)
Hyaline Membrane Disease (HMD)
| Chest x- ray
incrased opacity, ground glass appearance and air bronchogram
310
Infant Respiratory Distress Syndrome (IRDS)
Hyaline Membrane Disease (HMD)
| treatment / management
* correct hypoxemia (oxygood or NC)
* mainatin meutral themal environment
* recommend sufactant replacement therapy
* mechanical vent with PEEP for vent failure
311
How to correct hypoxemia on a neo with Infant Respiratory Distress Syndrome
* give O2
* CPAP 4-6 cmH2O
* Maintain PaO2 between 50-80 torr and SpO2 between 89-90%
312
# Neonatal resuscitation
secretions in the upper airway can be cleared by ...
wipping thenewborn's mouth and nose with a cloth
313
what to do during Neo resuscitation?
1. clear secreations
2. provide warmth
3. maintain patent airway ( extend the neck)
4. clear airway of aminiotic fluid or meconium (if present)
5. stimulate breathing by tactile stimulation
6. evaluate infant
7. administer O2
8. initiate PPV
9. Start chest compressions (when indicated
314
# Neonatal resuscitation
Stimulate breathing by
tactile stimulation by gentle rubbing the baby's back, trunck or textremities
315
# Neonatal resuscitation
If meconium is present and the baby is Not vigorous PPV should be initiated if ...
the infant is not breathing or the heart rate is less than 100/min after initial steps of resuscitation
316
# Neonatal resuscitation
Initiate Positive pressue ventilation when..
1. if newborn is apneic or has gasping respirations
2. if the HR is <100/min
317
# Neonatal resuscitation
If newborn is breathing but SpO2 is less than target range, you should..?
begin free-flow O2 at 0.30 using a blender and flow at 10L/min
318
# Neonatal resuscitation
Adjust FiO2 to achieve target values for saturation chart
| target pre-ductal SpO2 after birth
* 1 min - 60 to 65%
* 2 min - 65 to 70%
* 3 min - 70 to75 %
* 4 min - 75 to 80%
* 5 min - 80 to 85%
* 10min - 85 to 95%
319
# Neonatal resuscitation
Chest compression are indicated when ...
heart rate ramains < 60 /min despite 30 seconds of PPV
320
CF chest percussion
CP: hyperresonant or tympanic note
321
What med do you give for Severe Status asthmatic-us
Magnesium sulfate or epinephrine
322
this pattern involves graually increasing then decreasing Vt, followed by apnea. Associated with stroke, tarumatic brain injury or heart failure
Cheyne- Stokes
323
Cheyne stokes is tipically associated with ...
stroke, traumatic brain injury or heart failure
324
This pattern is characterized by irregular breathing with periods of apnea. It's often seen with central nervous systme trauma or increased intracrania pressure
Biot's respiration
325
Biot's respirations it's often seen with...
central nervous system, trauma or increased intracranial pressure
326
This is a deep and rapid breathing pattern often associated with metabolic acidosis, especially dabetic ketoacidosis (DKA). The body is trying to blow off CO2 to compensate
Kussmaul respirations
327
Kussmaul respiration are associated with ...
metabolic acidosis, especally diabetic ketoacidosis (DKA)
| Body is trying to blow off CO2
328
chest and abdomen moving in opposite directions. Its often seen in diaphragmatic fatigue or flail chest and may require ventilatory support
Paradoxical brething
329
Paradoxical breathing is often seen in...
diaphragmatic fatigue or flail chest and may require vent support
330
what position works best for CHF /Pulm. Edema
Fowler’s position
331
what type of therapy would you give a patient with CHF / p. edema .
High flow o2 therapy ( HFNC , non-rebreather )
Hyper inflation therapy
CPAP
332
what positive inotropic agent can you give a pt with CHF .
Digitalis
Digoxin
Docutamin
Dopamine
333
what analgesic do you give a CHF pt and why?
Morphine to slow down breathing
334
what antidysrhythmic agent do you give for CHF/ P.edema ?
Atropine (Brady)
Procainamide (Tachy)
335
what preload reduction agents do you give a pt with CHF ?
Nitroglycerin
Nitroprusside
Morphine
336
name a diuretic that you can give to a CHF pt?
Furosemide
337
CHF / p. Edema
Percussion
flat or dull percussion note
other: increased tactile and vocal fremitus
338
Treatment for SEVERE chest trauma- Flail chest
* Severe - Stabilization of chest (NPPV, VC/AC with peep for acute vent failure)
339
Treatment for SEVERE chest trauma - flail chest
* Severe - Stabilization of chest (NPPV, VC/AC with peep for acute ven failure)
340
Treatment for pulseless ventricular tachycardia
Defibrillation
341
Meds for CHF
Increase contractility
Digitalis
342
Meds for CHF
Promote fluid exertion
Lasix
343
Meds for CHF
What is Nipride
Vasodilator - reduces impedance of blood flow
344
Hyperinflation therapy examples
Is /SMI
IPPB
345
Myocardial / ischemia
ABG
Hypoxemia
346
Myocardial / ischemia
Electrolytes
Hyperkalemia or Hypokalemia
347
Myocardial / ischemia
Electrocardiogram
Inverted T waves
Elevated S-T segment
348
Myocardial / ischemia
Cardiac enzymes
Elevated Troponin
349
Treatment for emphysema
* low o2 spo2 is 88-92%
* aerosolized bronchodilators (SABA, LABA, anticholinergic, LAMA)
* bronchial hygiene as indicated
* inhaled corticosteroids
* antibiotics if indicated by sputum culture
* smoking cessation / nicotine therapy
* pulmonary rehabilitation
*consider NPPV for acute exacerbation
* proper nutrition
*education programs
350
Emphysema / c.bronchitis
Respiratory pattern
Dyspnea, accessory muscle use, pursed lip breathing
RRT
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