Term
| ≈ Tv / (plateau pressure-PEEP) |
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Definition
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Term
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Definition
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Term
| Volume inhaled during maximal forced inhalation after normal tidal inhalation |
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Definition
| Inspiratory reserve volume (IRV) |
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Term
| Volume exhaled during a maximal forced exhalation, starting at the end of a tidal exhalation |
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Definition
| Expiratory reserve volume (ERV) |
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Term
| Volume left in lung after maximum exhalation |
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Definition
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Term
| Volume of gas in the lungs when the small (dependent) alveoli begin to close |
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Definition
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Term
| Phase of expiration in which apex alveoli continue to empty after closure of basilar alveoli |
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Definition
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Term
| Closing volume may exceed FRC in the elderly, which may contribute to what 4 things? |
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Definition
1. Airway closure
2. Poor ventilation during normal tidal breathing
3. Intrapulmonary shunt
4. Poor oxygenation |
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Term
| What 3 things can increase closing volume? |
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Definition
Smoking
Lung disease
Supine position |
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Term
| Small alveoli are located in the (apex/base) of the lungs. |
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Definition
| Base (have more room to expand) |
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Term
| What happens to the closing volume as you age? |
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Definition
| The closing volume increases, eventually leading to atelectasis in the elderly. |
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Term
| What point during the respiratory cycle coincides with the point of peak lung compliance? |
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Definition
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Term
| Why is the FEV1/FVC ratio less accurate than the FEF25-75%? |
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Definition
FEV1/FVC ratio = effort-dependent, so it requires the patient to be able to forcefully exhale. It will be inaccurate in patients with neuromuscular disease, resp fatigue, or poor positioning.
FEF25-75% = effort-independent |
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Term
| Forced exhalation is used to determine the presence of (obstructive/restrictive) disease. |
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Definition
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Term
| Leads to difficulty inhaling & exhaling both |
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Definition
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Term
| Obstructive disease is an (inspiratory/expiratory) problem. |
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Definition
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Term
| Restrictive disease is an (inspiratory/expiratory) disease. |
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Definition
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Term
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Definition
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Term
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Definition
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Term
| Abnormal, permanent enlargement of air spaces distal to terminal bronchioles |
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Definition
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Term
| Destruction of alveolar walls/tissue, leading to decreased surface area available for gas exchange |
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Definition
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Term
| What is the criteria for diagnosis of chronic bronchitis? |
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Definition
| Chronic or recurrent periods of excess mucus in pulm tree for ≥ 3 mo out of the year for at least 2 successive years |
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Term
| T/F: Patients with COPD typically either have emphysema or chronic bronchitis, but rarely both. |
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Definition
False
Patients often have components of both emphysema & chronic bronchitis. It is rare for a patient to have exclusively one or the other. |
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Term
| Which component of COPD has the worst prognosis? |
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Definition
Chronic bronchitis
Patients often die w/in 5 yrs of 1st episode of acute resp failure |
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Term
| Which component of COPD is associated with acute resp failure, significant hypoxia, hypercarbia, & acidosis? |
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Definition
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Term
| What are the 3 main causes of COPD? |
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Definition
Cigarette smoking (#1 cause)
Environmental pollutants (smog, 2nd hand smoke)
Alpha-1 Antitrypsin deficiency (genetic) |
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Term
| Why does an Alpha-1 Antitrypsin deficiency cause COPD? |
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Definition
| Alpha-1 Antitrypsin is a protease inhibitor (protects against lung damage), so lung damage results if it is deficient. |
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Term
| If a patient has an Alpha-1 Antitrypsin deficiency, at what age would you expect the patient to have developed COPD? |
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Definition
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Term
| What is the dominant feature in COPD? |
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Definition
| Progressive airway obstruction |
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Term
| Which airway disease would likely result in cor pulmonale & the following ABG's: PaO2 <60 mm Hg & PaCO2 >45 mm Hg? |
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Definition
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Term
| Which airway disease would likely result in the following ABG's: PaO2 >60 mm Hg & normal PaCO2? |
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Definition
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Term
| What might you expect to see on a pre-op CXR in a patient with COPD? |
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Definition
Hyperlucency (d/t arterial vascular deficiency)
Flattened diaphragm
Bullae (w/emphysema)
Infiltrates |
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Term
| How might a CT scan be helpful in assessing COPD? |
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Definition
| Allows you to examine the lung parenchyma & quantify the degree of air trapping |
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Term
| Cor pulmonale is much more common with (chronic bronchitis/emphysema). |
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Definition
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Term
| (Chronic bronchitis/Emphysema) is characterized by thin, purse lip breathing, use of accessory muscles, & markedly diminished breath souths. |
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Definition
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Term
| (Chronic bronchitis/emphysema) is characterized by dyspnea at onset. |
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Definition
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Term
| What class of drugs is best for use as a rescue inhaler? Give an example of a drug that would be used. |
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Definition
| Short-acting Beta2 agonists (ie Albuterol) |
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Term
| What class of drugs is recommended for management of non-asthmatic COPD? |
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Definition
Long-acting anticholinergics
Ex: Tiotropium (Spiriva)
[Mainstay tx is bronchodilators rather than corticosteroids]
Bronchodilators |
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Term
| Corticosteroids improve COPD symptoms in what % of patients? |
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Definition
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Term
| What class of drugs is recommended as first-line treatment of COPD? |
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Definition
| Anticholinergics (Bronchodilators) |
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Term
| Which drug is only used for refractory COPD? |
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Definition
| Theophylline (a methylxanthine) |
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Term
| Which drugs affects both β1 & β2 receptors via catecholamine release? |
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Definition
| Theophylline (a methylxanthine) |
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Term
| In a patient with known COPD, what 2 factors are important to consider during the preop assessment? |
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Definition
Surgical site & preop status
(Upper abdominal or thoracic surgery = higher pulm risk) |
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Term
| What are 3 indications for applying supplemental Oxygen preop? |
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Definition
PaO2<60 mm Hg
Hct > 55%
Cor pulmonale |
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Term
| What does a low FEV1 correlate with? |
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Definition
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Term
| What labs would you expect to see in a patient who is a chronic CO2 retainer? |
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Definition
High PaCO2
High bicarb
Normal pH
(b/c kidneys have had time to compensate) |
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Term
| What 3 things should you consider if planning to do regional anesthesia on a patient with COPD? |
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Definition
Avoid sensory blockade above T6 (won’t tolerate loss of accessory muscles)
Be cautious w/ sedation
Consider whether or not the pt will tolerate lying flat (may have to do GA) |
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Term
| Name 3 reasons why general anesthesia can increase the A-a gradient (Alveolar-arteriolar PO2 difference). |
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Definition
| Supine position, loss of inspiratory muscle tone, & atelectasis with GA |
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Term
| What are the important goals in a COPD patient post-op? |
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Definition
Minimize pulm complications (atelectasis, pneumonia,hypoxia)
Early ambulation, Incentive spirometry
Control post-op pain (consider RA blocks when possible) |
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Term
| What is the central feature of asthma? |
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Definition
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Term
| What are the 3 outcomes involved in both intrinsic & extrinsic asthma? |
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Definition
Bronchoconstriction
Increased mucosal wall edema
Increased mucus secretion |
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Term
| Give an example of a drug that is a mast cell stabilizer. |
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Definition
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Term
| Daily asthma episodes eventually result in what? |
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Definition
Epithelial desquamation & fibrosis -->
Bronchial hyperresponsiveness & airway destruction |
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Term
| What mediator is most important in causing bronchospasms in asthma patients? |
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Definition
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Term
| T/F: Airway smooth muscle extends to the respiratory bronchioles. |
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Definition
False
Airway smooth muscle extends to the terminal bronchioles. |
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Term
| (PSNS/SNS) mediate baseline smooth muscle tone in the airways. |
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Definition
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Term
| What causes FEF25-75% to be reduced? |
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Definition
High airway resistance
Ex: Asthma |
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Term
| Which class of drugs is used to treat extrinsic asthma only? |
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Definition
Anti-IgE Antibody Agents
Ex: Omalizumab (Xolair)
Block IgE from binding to mast cells
--> prevents mast cell degranulation |
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Term
| Regional Anesthesia is thought to be safer than GA in (Asthma/COPD/both) |
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Definition
Asthma (b/c avoids instrumentation of the airway --> less risk of bronchospasm)
COPD pts are at risk of pulm complications whether use RA or GA |
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Term
| What 2 things may worsen tracheal stenosis? |
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Definition
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