Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Coexisting conditions > Asthma > Flashcards

Asthma Flashcards

1
Q

What are the asthma stats?

What is it attributed to?

A
  • One of the most common chronic conditions worldwide
  • 300 million people globally
    • Increasing in developing countries
  • attributed to air polution
  • genetic and environmental components
    • strongly influenced by genetics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What does asthma do to the airways?

A
  • Chronic inflammatory disorder of the airways characterized by increase responsieness of the tracheobronchial tree to a variety of stimuli
  • Airways are enflamed, edemetous, and hypersensitive to irritants
  • Severe cases will have airway wall thickening
    • increased epithelium, submucosa, and smooth muscle tone
  • Reversible expiratory flow obstruction
    • from hyperactivity and constriction
    • degree varies over time; dynamic disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the symptoms of Asthma?

A
  • Wheezing
  • breathlessness
  • chest tightness
  • cough (night and early am)
  • tachypnea
  • prolonged expiration phase
  • fatigue
  • variable airflow obstruction that is reversible
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are asthma triggers?

A
  • allergens
  • drugs
    • aspirin
    • NSAIDS
  • infections
  • exercise
  • emotional stress
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the pathophysiology of asthma?

What are the inflammatory mediators?

A
  • Activation of inflammatory cascade releases mediators from mast cells that interact with receptors in bronchial wall and the autonomic nervous system to cause bronchoconstriction
  • Inflammatory mediators:
    • histamine
    • leukotrienes
    • prostaglandins
    • substance P
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What cells infiltrate the airway mucosa?

What does this cause?

A
  • Cells:
    • eosinophils
    • neutrophils
    • mast cells
    • T lymphocytes
    • leukotrienes
    • basophils
  • Causes bronchial edema and thickening of the airway
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How is Asthma diagnosed?

A
  • By looking at physical symptoms and pulmonary function tests
    • baseline compared to after bronchodilator therapy
    • if improvement is seen, asthma is indicated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What would you expect to see on the PFT of a pt with asthma?

A
  • Decreased FEV1 and FEF25-75% (Maximum mid expiratory flow rate (MMEF))
    • direct measurement of expiratory flow rate obstruction
    • extent of decrease reflects the severity of expiratory obstruction
  • During asthma attach FEV1 <35% and MMEF <20%
  • Flow volume loop show a characteristic downward scooping of the expiratory limb
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is considered mild to moderate asthma?

what would an ABG look like?

A
  • FEV1 <80%
  • PaO2 and PaCO2 normal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What does severe asthma look like on PFTs?

ABG?

A
  • FEV2 < 25%
  • PaO2 may be < 60 mmHg and hypercarbia may develop
  • respiratory muscle fatigue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What does PaCO2 usually do with a pt with asthma?

A
  • PaCO2 often decreases as a result of hyperventilation, a neural reflex to bronchoconstriction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What would you expect a CXR to look like for a pt with asthma?

A
  • hyperinflation of the lungs
  • hilar vascular congestion from mucous plugging and pulm hypertension if disease is severe
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the pharmacologic approach for pts with asthma?

How is this done?

A
  • prophylactic approach; treat underlying inflammation
    • as opposed to just treating bronchospasm
  • Inhaled or systemic corticosteroids
    • decreased bronchial mucosa inflammation and hyper-responsiveness
    • advair
  • Cromolyn
  • Leukotriene inhibitors
  • Methylxanthines- phosphodiesterase inhibitors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the rescue medications used for a severe asthma attack?

A
  • Beta-2 adrenergic agonists- albuterol, terbutaline
    • B2 receptor activation of adenylate cyclase with increased cAMP concentrations and bronchodilation
    • SNS side effects: tachycardia, dysrhythmias, potassium shits
  • Anticholinergic drugs- ipratropium
    • blocks muscarinic recepors = bronchodilation
    • less effective than B2 in asthmatics
    • can prolong effects of B2 inhalors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What should we assess pre-induction for a patient with asthma?

A
  • H&P
    • breath sounds
  • PFTs before and after bronchodilator therapy for major surgery
    • FEV1/FVC should be > 70-80% expected or personal best prior to surgery
    • FEV1/FVC <60% - risk for pulmonary morbidity
  • CXR- looking for changes over time
  • ABG- non necessary unless questionable oxygenation/ventilation prior to elective surgery
  • Continue current asthma medications into peri-op period
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Benzos vs opioids in a pt with asthma?

A
  • benzos are a good choice b/c anxiety can precipitate bronchospasm
  • opioids- consider resp depressant effect
17
Q

How can you prevent bronchoconstriction perioperatively?

A
  • Pre-op bronchodilators- albuterol before induction
  • pre-op steroids
    • If starting inhaled staroids, should start 48 hrs prior to surgery
    • hydrocortisone 100 mg q 8 hours on day of surgery if FEV1 <80%
      • may need stress dose steroids
18
Q

What are the goals for GA?

Regional?

A
  • General should be designed to:
    • depress airway reflexes
      • LMAs are better tolerated, less airway manipulations
      • IV lidocaine 1-1.5 mg/kg, and opioids
      • LTA- topical lidocaine
      • propofol (no metabisulfites) and ketamine best
    • avoid hyperactivity
    • treat bronchoconstriction
    • avoid histamine release
  • consider regional, to avoid airway issues, but remember to avoid stressing them
19
Q

What VA and NMB would you use for pts with asthma?

A
  • Sevo and halothane are less pungent; less coughing to trigger bronchospasm
    • use high concentration >1.5 MAC for dilation and bronchial reflex inhibition
    • need strong CV system for this
  • Avoid NDMRs that release histamine
    • atracurium
    • mivacurium
    • d-tubo
  • Anticholinesterase:
    • neostigmine ok if given with anticholinergic
20
Q

Why would you not want to use thiopental (if it was available) in an asthmatic pt?

Whats the concern with propofol?

A
  • releases histamine
  • Propofol- generic has sulfites that can cause reaction
21
Q

What is the induction drug of choice for the asthmatic pt?

A
  • Ketamine for bronchodilator effects
  • stimulates secretions, so give with anticholinergic
22
Q

Which opioids should be avoided in asthmatics?

non opioid pain meds?

A

morphine

meperidine

nsaids

asa

23
Q

Which VA can irritate the airway?

A

Isoflurane

Desflurane- really bad

24
Q

How should you emerge a pt with asthma?

A
  • goal for a smooth emergence
  • Possibly extubate deep if appropriate
25
Q

how can you treat intraoperative bronchospasm?

A
  • attach albuterol to T-piece of ETT and give dose
26
Q

How do you want to manage fluids in a pt with asthma?

A

liberal hydration to decrease viscosity of secretions

27
Q

How do you want to ventilate an asthmatic patient?

A
  • decreased RR 8-10 bpm
    • need adequate exhalation times
  • Prolong I:E ratio
  • Increase TV to maintain normal PaCO2
    • Avoid excessive peak airway pressures (>40 cmH2O)
28
Q

What is the differential diagnosis of intraoperative wheezing?

A
  • foreign body (gastric tube in lung)
  • partially blocked/kinked ETT
  • light anesthesia
  • aspiration
  • endobronchial intubation
  • pneumothorax
  • pulmonary embolus
  • pulmonary edema
  • acute exacerbation of asthma
29
Q

What do you do if your pt bronchospasms during anesthesia?

A
  • Administer 100% O2
  • deepen the level of anesthesia with a VA or IV drug
  • administer B2 agonist
  • in severe cases administer epi IV
    • infusion 2-8 mcg/min
    • SQ 0.3-0.5 mg q 20-30 min
  • consider IV corticosteroids
    • 1-2 mg/kg of cortisol
  • consider IV aminophylline
30
Q

Would you take a pt who is actively wheezing to the OR?

A

NO!! You should avoid this at all costs!! Especially if the procedure is elective

31
Q
A

Coexisting conditions (34 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions