Morning Report 10/13/15: COPD and Acid/Base

Teaching Pearls:

  • Only two interventions shown to reduce the progression of COPD: Smoking cessation and supplemental O2
  • Stepwise Approach to Acid Base: 
    • Acidic or Alkalotic?
    • Primary Disturbance? Respiratory or Metabolic
    • Calculate the Anion Gap
    • If Anion Gap present, calculate the Delta Gap
    • If metabolic acidosis present, use Winter’s formula to calculate whether there is appropriate respiratory compensation
  • For every 10 increase in pCO2, the bicarb should increase by 1 in acute respiratory acidosis and 3.5 in chronic respiratory acidosis
  • BIPAP can be used to improve respiratory acidosis, increase pH, decrease risk of intubation, and to reduce the pCO2
  • Contraindications of BIPAP include respiratory arrest, CV instability, altered mental status, aspiration risk/significant secretions, nasopharyngeal abnormalities, cranofacial trauma
  • Right Bundle Branch Block: Causes include RVH, cor pulmonale, PE, ischemic HD, myocarditis. Look for Broad QRS > 120ms, RSR prime in V1-V3, wide slurred S in the lateral leads V5-V6

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