Icm Fall Copd

Front 1

what do you want to ask a pt with hx of SOB (COPD)

Back 1

1. time course: progressively worse over a few days or sudden onset

2. Associated sx; CHest pain

3. Trauma, aspiration, underlying lung disease, infections

4. MEDS

5. History of similiar problem

Front 2

what can be some causes for SOB hx

Back 2

1. trauma
2. aspiration
3. underlying disease
4. infections/exposure to infections

Front 3

what are some conditions that go along with SOB

Back 3

asthma
emphysema
CHF

Front 4

what things do you need to look at for a pt with cc SOB

Back 4

1. AIRWAY- is it protected. can he speak

Front 5

wht are the generals to look for with SOB

Back 5

appearance,
mental status
vitals
ability to talk

Front 6

should we look at a pts skin if thier cc is SOB

Back 6

look for cyanosis at fingers and lips

*also look for edema

Front 7

should we listen to heart with cc SOB

Back 7

ALWAYS

Front 8

whats on the lung exam for pt with CC SOB

Back 8

1. breath sounds
2. wheeze- asthma
3. use of accessory mm
4. Peripheral edema

Front 9

for a pt with cc SOB do we intubate

Back 9

depends.
intubate if:
1. pt cant clear secretions
2. decreased/deteriorating ABG
3. Acute respiratory failure: abnomral ventilation, diffusion, perfusion, control of breathing, O2 drop CO2 high

Front 10

what is hypercapnic respiratory failure:

what is nonhypercapnic heart failure

Back 10

increased CO2, normal/decreaseed O2

decreased O2, normal CO2

**do several ABG

Front 11

what are 7 big ddx for SOB

Back 11

1. Asthma
2. Bronchitis
3. emphysema
4. pneumonia
5. pnumothorax
6. PE
7. CHF

Front 12

whats asthma

Back 12

cycles of wheezing stim by a specific stimuli

Front 13

bronchitis

Back 13

cough daily, productive 3 mo-1year
common in smokers, old men
*excess mucous causes poor ventilation (low O2, high Co2)
*leads to polycysthemia, Pulm HTN --> cor pulmonale,

Hx: dyspnea, smoking, TONS of sputum

PE: blue. cachexic, wheeze, rales, decreased breath sounds

Front 14

what does this describe, an old man who is a smoker who has had a cought for like 6 months and is always coughing junk up

Back 14

bronchitis

he might be a little blue and a little cachexic

Front 15

tell me about emphysema

Back 15

associated with SMOKING. (rare but can be alpha 1 antutrypsin defecit)
flat diaphragm
men

**when alveoli are are enlarged and walls break down (distal to terminal bronchiole)

PE barrel chest wheeze decreased breath sounds, flath diaphragm

Front 16

an old barrel chested man with flatened diaphragms

Back 16

emphysema

**sMOKER

Front 17

tell me about pneumonia

Back 17

1. all ages, dangerous at extremes
2. Commonin DM, EtOH, immunodeficient

*causative organism in sputum/blood cultures

**aspiration pneumonia by an anerobic organism (other are areobic)

Hx: fever, cough, sputum, hemoptyosis

Egophony (E to A) decreased breath sounds, increased rematus

Front 18

in a person with a productive cough wat can help you distinguish bronchitis from pneumonia

Back 18

1. Bronchitis, cachexic smoker. blue. wheeze, decreased breath sounds

2. Pneumonia: any age, DM, EtOH, immundodeficient. Egophony, fever, fremetis

Front 19

tell me about pneumothorax

Back 19

*common in ppl with underlying lung disease (asthma, COPD, malignancy) can be sporadic in tall thin males

**SUDDEN onset

**spontaneous rupture of a pulm or subpleural BLEB

*UL breath sounds, JVD, tracheal deviation

Front 20

what disease is associated with an empheysematous bleb

Back 20

pneumothorax when the bleb ruptures

SUDDEN sob, pain,

UL breath soudns, tracheal deviation

Front 21

tell me about PE

Back 21

old, surgery recently, malignancy, prolonged immobilization, preggo, clot formed on port

*most from legs

Large: hypotension, shock
Small: dyspnea, pleuritic pain, hypoxia

SUDDEN onset SOB, sharp pleuritic chest pain, hemopytysis, anxiety, syncope is rare

PE tachy cardic, cyanotic, febrile

Front 22

what is HR and temp with PE

Back 22

HIGH!

Front 23

whats CHF

Back 23

old, hx heart disease. cardiac risk factors

*L vent dysfx leads to velvated venous pressure and fluid in LE. fluid can back up into lungs

can be caused by increase na, MI, tachydysrhythemias,

Hx: couth, orthopenia, PND< chest pain, risk factors

Rales, wheeze, JVD, gallop, edema, diaphoretic

Front 24

what disease

PE: rales, wheexe, edema, JVD, sweathy, gallop

Back 24

CHF

Cough orthopnea, PDN, cheast pain, risk factors

Front 25

what is the Aa gradiant

Back 25

defiens hypoxia

Front 26

ok so be sure to do the following on SOB

1. CBC
2. CXR
3. FEV1/PEFR
4. Gram Stain
5

Back 26

1. increased WBC is infectious pneumonia (stress and b agonist will increase WBC)

2. flat diaphragm with emphysema, also a barrel chest (increased AP diameter) . increaesd bronchovascular markings

3. FEV1/PEFR: LOW, improve with b agonist. shows disease is reversible

4. infection can aggregate COPD

Front 27

tell me about oxygen and COPD

Back 27

in COPD CO2 retention is a problem

**thier respiratory drive is from hypoxia, NOT CO2 like normal

**so if you over O2 we can decreae their need to breathe- lethargy is the first sigh

Front 28

if our our pt with COPD is on O2 adn becomes lethargic what do we do

Back 28

STOP/DEcrease O2

**their drive to breath is based on hypoxia, if we correct this we take away their drive to breath adn they stop!!!! BAD

**use a venturi mask to monitor O2

Front 29

whats the dig in giving o2 with venturi maks vs nasal prongs

Back 29

venturi- better to monitor (good for COPD who needs hypoxemia to breath)

Front 30

tell be about b agonists

Back 30

allbuterol, stim bronchodilation

**can increase WBC

Front 31

steroids

Back 31

good to decrease inflammation as in asthma

Front 32

do we use anticholinergics in pts with COPD

Back 32

ya, along with b angonists to open airways

Front 33

what is theophylline

Back 33

used in chronic COPD pts but is not a mainstay, need to monitor levels

Front 34

what OMT is good for COPD

Back 34

rib raise
postural drainiage
lymphatic pump
restirction in throacic motion restored as needed

Front 35

when to tx with AB

Back 35

when its pneumonia, + cultures or high index of suscipion use emperical