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