RESPIRATORY
COPD
PromptImportant things to look for on an ABG
ResponseSevere ACUTE respiratory acidosis
CHRONIC respiratory acidosis with metabolic compensation
Raised A-a Gradient - Relative hypoxia for FiO2
CHRONIC respiratory acidosis with metabolic compensation
Raised A-a Gradient - Relative hypoxia for FiO2
PromptDrugs used to treat COPD
ResponseB-agonist (Salbutamol) - bronchodilator - history of reversible component of airways disease on lung function testing or anecdotal improvement with prior treatment
Anticholinergic (Ipratropium) - prevention of bronchospasm and decreased secretions to decrease airflow resistance and mucosal plugging. Use if increased WOB or wheeze
Oxygen - if demonstrable hypoxia below patients baseline or evidence of respiratory distress (Tachypnoea, air hunger)
Glucocorticoids (prednisone) - decreased inflammation/oedema/mucous production in obstructive lung disease. Indicated if global wheeze evident on exam (accept marked prolongation of expiratory phase indicating obstruction to airflow)
Antibiotics - to treat probably precipitant that could be bacterial - indication = severe exaccerbation/fever/change in sputum volume or colour/sick contacts
Anticholinergic (Ipratropium) - prevention of bronchospasm and decreased secretions to decrease airflow resistance and mucosal plugging. Use if increased WOB or wheeze
Oxygen - if demonstrable hypoxia below patients baseline or evidence of respiratory distress (Tachypnoea, air hunger)
Glucocorticoids (prednisone) - decreased inflammation/oedema/mucous production in obstructive lung disease. Indicated if global wheeze evident on exam (accept marked prolongation of expiratory phase indicating obstruction to airflow)
Antibiotics - to treat probably precipitant that could be bacterial - indication = severe exaccerbation/fever/change in sputum volume or colour/sick contacts
PromptEndpoints for effective NIV
ResponsePatients percieved breathlessness
Patients respiratory work and respiratory rate
Tidal volumes/minute ventilation from machine feedback
Blood gase eviden of decrementing CO2, incrementing pH
Patients respiratory work and respiratory rate
Tidal volumes/minute ventilation from machine feedback
Blood gase eviden of decrementing CO2, incrementing pH
PromptManagement of Severe COPD failing NIV
ResponseIntubate
Hyperventilate to decrease CO2
Reduce FiO2
IV antibiotics - ceftriaxone 1g/azithromycin 500 mg
IV fluids - 500 mL + repeat to SBP >100
Hyperventilate to decrease CO2
Reduce FiO2
IV antibiotics - ceftriaxone 1g/azithromycin 500 mg
IV fluids - 500 mL + repeat to SBP >100
PromptAcute vs Chronic changes
ResponseAcute vs chronic changes equation used for compensation and expected bicarbonate - blood gas interpretation depends on clinical history. A gas without history is uninterpretable.
Normal blood gas can have mixed acidosis/alkalosis
Normal blood gas can have mixed acidosis/alkalosis