COPD Snapshot

DEFINE: A lung disease that is a combination of chronic bronchitis and emphysema. This disease limits airflow due to inflammation and C02 retention. These individuals often have a chronic cough, wheezing, shortness of air, and increased mucus production. The also generally have destruction of inter-alveolar septa destruction. Alveoli sacs are where 02 and C02 exchange happens.

1. Smoker
2. Alpha 1 antitrypsin deficiency
3. Chemical irritant exposure

1. Shortness of air
2. Wheezing
3. Tight chest
4. Increased mucus production

1. Barrel chest
2. Clubbing fingernails
3. Wheezes**
4. Rhonchi
5. Decreased lung sounds
6. Thick sputum**
7. Percussion: hyper-resonance
8. Cyanosis

1. Spirometry; FEV1/FVC ratio <70%
2. CBC- may see elevated hit
3. Pulse oximetry: Varies from patient to patient but often seen 88-92%
4. ABG: C02 is often elevated
5. D-dimer
6. Continuous pulse oximetry
7. A1-antitrypsin screen (specifically in those <45 yrs old)
8. CXR: Hyperinflation
9. PFT
10. Sleep studies
11. Sputum culture

STAGES: (FEV1=Amount of air that can be forcefully expelled in 1 second)
1. Stage 1- Mild FEV1 80% greater than or equal to this. May have some mild shortness of air and increase mucus. Also an ongoing chronic cough
2. Stage 2- Moderate FEV1 between 50-79%
3. Stage 3-Severe FEV! Between 30-49%
4. Stage 4- END STAGE Very severe. FEV1 <30%
5. Lung transplant. 02 around the clock

1. Short acting B-agonist: Example: Albuterol scheduled and PRN
2. Anticholinergic-example: Ipratropium, Tiotropium. These meds ease the airways
3. Long Acting B-agonist: Salmeterol, Formoterol
4. Expectorants
5. Oxygen (typical 2-3 L in pm)

1. IV steroids
2. Empiric antibiotic
3. 02 nasal cannula

1. Recent URI
2. Influenza
3. Allergies
4. Environmental irritants
5. Weather changes

1. Vaccination- pneumovax & influenza recommended
2. Smoking cessation
3. Your airflow (in & out) is limited due to obstruction, thus you may have ongoing mild shortness of air. If you shortness of air suddenly increases you should be seen ASAP by a medical healthcare
provider (Emergency Room)
4. Pursed lip breathing
5. Avoid triggers: cold air, infections, air pollutants, cigarette smoke
6. Eat smaller more frequent meals

1. Pulmonologist

1. Chronic anemia
2. Respiratory failure
3. Right ventricular hypertrophy
4. Recurrent lung infections
5. Cor pulmonale: right sided heart failure secondary to COPD

DIFFERENTIAL DIAGNOSIS (Dx that can appear similar)
1. Congestive heart failure
2. Bronchitis
3. Pneumonia: Fever, more acute
4. Asthma: may be younger.
5. Lung cancer
6. Chronic pulmonary embolism
7. Bronchiectasis
8. Reactive airway
9. Bronchospasms

1. Emphysema
2. Blue Bloater
3. Pink Puffer
4. Hypoxic drive theory
5. Hypoxia
6. Hypercapnia
7. Spiromerty
8. FEV1

1. American Lung Association
2. National Heart, Lung, And Blood Institute
3. Medscape
4. COPD Foundation
1. The 5-minute Clinical consult 2015 43rd Edition page 240. Alan J Crop MD, Bryon Veynovich. Editor in Chief Frank J Domino
2. Epocrates COPD May 2016
3. COPD Foundation
4. Healthline, End-Stage COPD, Written by Rachel Nall, RN, BSN, CCRN Medically Reviewed by Mark R Laflamme, MD on November 19, 2015
5. UPMC Life Change Medicine

Update on May 2nd,2016


Myocardial Infarction Snapshot

Myocardial Infarction

AKA: MI, Heart attack, Coronary thrombosis, STEMI, NSTEMI, AMI, ACS

SYMPTOMS: Chest pressure, chest tightness, chest pain, shortness of air, nausea, impending doom, anxiety, left arm, left jaw pain, dizziness

RISK FACTORS: Family hx heart disease, smoking, hyperlipidemia, previous MI, hypertension, Diabetes

MEDICATIONS USED FOR IMMEDIATE TX: Aspirin, Morphine, Nitroglycerin, Oxygen

OTHER MEDS THAT MAY BE USED: Clopidogrel, Prasugrel, Ticagrelor

SOME POTENTIAL DRIPS: Heparin drip, Nitro drip, Alteplase, Integrilin

TESTS: EKG, Cardiac enzymes (ex: troponin), lipids, CBC, CMP, BNP, CXR, Echo, stress tests

TREATMENT GOAL: Restore as much perfusion of blood flow to heart to reduce/mitigate amount of heart damage-ischemia

PROCEDURES: Percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery, stent placement

MEDICATIONS RX ONGOING: Statin, aspirin, anticoagulant, ace inhibitor, beta blocker

AFTER CARE: Cardiac rehab, heart healthy-low sodium diet, Weight loss as indicated, smoking cessation

DIFFERENTIAL DX: Pulmonary embolism, CHF exacerbation, COPD exacerbation, Anxiety, Acid reflux




The 5 Minute Clinical Consult Standard 2015, 23rd Edition Wolters Kluwer. Frank J Domino (Editor in Chief) Associated editors R. Balder, J. Golding, J. Grimes.



Pulmonary Embolism Snapshot

AKA: Lung clot, PE

SYMPTOMS: Shortness of air, dyspnea, chest pain, potential leg pain (if DVT first), chest tightness, anxiety, coughing (sometime with blood), diaphoretic

PHYSICAL EXAM: Tachypnea, tachycardia, hypotension, cyanosis, low 02 saturation

RISK FACTORS: Current DVT, PE or DVT history, Long period best rest, Recent long travel (road trip, plane), family history, clotting disorder (Factor V Leiden), malignancy, birth control, estrogen, smoking, recent surgery, implantable devices, obesity

LABS & TESTS: May consider EKG, Cardiac enzymes, CXR, BNP, ABGs, etc., first depending upon the situation, in order to r/o other causes. More specific tests, if PE specifically suspected, are: D-dimer, CT of chest with contrast (important with contrast), VQ scan if can’t do CT due to renal function (contrast). Will also want to get PT/INR monitoring especially if placed on heparin drip (protocol) and or warfarin.

MEDICATIONS EMERGENT: Lovenox therapeutic dose or the drip below

DRIPS: Heparin (Heparin drip vs SQ Lovenox- usually one or the other)

PROCEEDURES: Inferior vena cava filter (aka: Green filter) (if recurrent and or anticoagulants are contraindicated)

CHRONIC MEDICATIONS: Anticoagulants (Ex: Warfarin)

CONSULTANTS: Pulmonology

TOOLS: Wells Score tool (Score >6 high probability)

WAYS TO PREVENT: Lovenox prophylaxis dose (in hospital, ongoing bed rest, risk to develop), compression stockings, regular physical activity

Note: This is not an all-inclusive list. This is a generalized overview list


Delirium Tremens Snapshot

AKA: DTs, Alcohol withdrawal

WHAT IS IT: Withdrawal symptoms that generally start a couple of days after an alcoholics last drink

SYMPTOMS: Auditory & visual hallucinations, nausea/vomiting, diarrhea, pins & needles, agitation, shaking, confusion, anxiety, palpitations, chest pains (MedlinePlus)

PHYSICAL ASSESSMENT: Fever, tachycardia, high blood pressure, pale skin color, diaphoretic, tremors, tachypnea

RISK FACTORS: Stopping chronic alcohol use abruptly

EMERGENT MEDICATIONS USED FOR TX: Lorazepam, Valium (benzodiazepines help prevent seizures)

OTHER MEDS THAT MAY BE USED: Folic acid, magnesium, multivitamin, thiamine injection, Famotidine (alcoholic gastritis), Zofran


ABNORMAL LABS COMMONLY SEEN: Click here to see the post listing commonly seen labs

TESTS: EKG, ETOH level, Mag, phosphorus, CBC, CMP, GABA, Urine drug screen, ABG’s

COMPLICATIONS: Seizures, myocardial infarction, liver complications, gastritis, Wernicke encephalopathy, Wernicke Korsakoff Syndrome, severe electrolyte disturbances, injury from seizures

TREATMENT GOAL: Prevent seizures, control agitation, control nausea & vomiting, and other uncomfortable symptoms, prevent injury

NURSING ORDERS/PROCEDURES: Seizure, fall, elopement precautions. Psyche consult as indicated for depression/SI/HI, CIWA (3)

AFTER CARE: AA meetings, Counseling,

DIFFERENTIAL DX: Opioid overdose, illicit drug use overdose, encephalopathy, stroke, amphetamine toxicity Click here for a more comprehensive list on


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