BCEMP (questions with complete
solutions) already passed
What are equivalent mdi vs nebs for asthma exacerbation - ANS ✔✔2.5 mg neb or 4-8 90mcg
puffs every 20 min
Asthma - Mild/Moderate - ANS ✔✔No AMS, SaO2 90%-95%, can speak in sentences, HR 100-
120, increased RR, prefers sitting, may or may not be wheezing
Asthma - Severe - ANS ✔✔Agitated/confused/drowsy, O2<90%, speaks in words not sentences,
HR > 120, RR > 30, sits hunched forward, no wheezes (chest quiet)
Asthma related death risk factors - ANS ✔✔Previous ICU admit or intubation, >/=2 hospital
admits for asthma in past year, low socioeconomic status, current or recent corticosteroid use,
poor adherence to inh steroid, food allergy, hx of psych disease, coexisting illness (pna, diabetes,
arrhythmia)
primary therapy for asthma exacerbation - ANS ✔✔O2, inhaled B2 agonist, inh anticholinergics,
systemic steroids
Adjunct therapies for asthma exacerbation - ANS ✔✔Mag sulfate, Eli, methylxanthines,
leukotriene receptor antagonists, abx
Target O2 for children 6-11 - ANS ✔✔94%-98%
Target O2 for adults - ANS ✔✔96%
,Is intermittent or continuous nebs better? - ANS ✔✔Neither (conflicting data)
Key takeaways for asthma exacerbation - ANS ✔✔Albuterol, inh ipratropium, and oral or IV
steroids reduce complications and hospitalization rates
Key takeaways COPD - ANS ✔✔Abx are indicated for vented patients or ones who meet criteria
based on cardinal symptoms but abx should only be for 5-7 days.
Key takeaways CAP - ANS ✔✔Abx is based on comorbidities, severity, and risk factors for PA and
MRSA
Best approach for post-intubation analgesia and sedation - ANS ✔✔IV bolus therapy for acute
needs prior to increasing infusion rates
Ipratropium key points - ANS ✔✔Not monotherapy, with albuterol it improves bronchodilator
effect. Reduces rates of admission in pts with severe obstruction of airflow (esp kids) no benefit
after hospitalization
Systemic Corticosteroids in asthma - ANS ✔✔Improved lung fct., reduced hospitalization, lower
rate of relapse after discharge, oral and IV equally effective. Higher doses do not have more
efficacy and carry more risk.
Mag Sulfate - Asthma - ANS ✔✔2g IV over 20 min. Helps in kids, maybe adults. Improved lung
fct. Reduced rates of hospitalization in kids and maybe severe adults.
Steroid dose for asthma - ANS ✔✔Prednisone 1mg/kg/day oral max 50mg. Or prednisone 40-80
mg/day oral, Or adults hydrocortisone 500mg/dose oral or methylprednisolone 125mg/dose IV
or IM kids 1-2 mg/kg/day of prednisolone/prednisone oral 40mg max.
, Cardinal symptoms of COPD - ANS ✔✔Cough increased in frequency/severity. Increased sputum
volume or change of character. Dyspnea increased.
Causes of COPD exacerbations - ANS ✔✔Viruses, bacterial infections, environment (pollution or
temp)
Rule outs for COPD exacerbation (differential DX) - ANS ✔✔Pna, pleural effusion, pulmonary
edema, pneumothorax, PE, cardiac dysthymia
Treatment of mild COPD exacerbation - ANS ✔✔Short acting bronchodilators (can be controlled
with increase in regular meds)
Treatment of moderate COPD exacerbation - ANS ✔✔Short acting bronchodilator, oral steroids,
oral abx
Treatment of severe COPD exacerbation - ANS ✔✔ED and/or hospitalization
Presentation of non-life-threatening acute respiratory failure COPD - ANS ✔✔RR>30, accessory
muscle use, requires Venturi mask at 24-35% FiO2, increase in PaCO2
Presentation of life threatening acute resp failure COPD - ANS ✔✔RR >30, accessory muscle
use, acute change in mental status, >40% FiO2, PaCO2 >60 mmHg or pH<7.25
Risk factors for COPD exacerbation - ANS ✔✔Concomitant asthma, allergic phenotypes, high
degree of inflammation, past exacerbation, chronic bronchitis
COPD exacerbation mgmt - ANS ✔✔Resp support, inhaled b2 agonists+/-short acting
anticholinergics, systemic corticosteroids, abx if indicated
solutions) already passed
What are equivalent mdi vs nebs for asthma exacerbation - ANS ✔✔2.5 mg neb or 4-8 90mcg
puffs every 20 min
Asthma - Mild/Moderate - ANS ✔✔No AMS, SaO2 90%-95%, can speak in sentences, HR 100-
120, increased RR, prefers sitting, may or may not be wheezing
Asthma - Severe - ANS ✔✔Agitated/confused/drowsy, O2<90%, speaks in words not sentences,
HR > 120, RR > 30, sits hunched forward, no wheezes (chest quiet)
Asthma related death risk factors - ANS ✔✔Previous ICU admit or intubation, >/=2 hospital
admits for asthma in past year, low socioeconomic status, current or recent corticosteroid use,
poor adherence to inh steroid, food allergy, hx of psych disease, coexisting illness (pna, diabetes,
arrhythmia)
primary therapy for asthma exacerbation - ANS ✔✔O2, inhaled B2 agonist, inh anticholinergics,
systemic steroids
Adjunct therapies for asthma exacerbation - ANS ✔✔Mag sulfate, Eli, methylxanthines,
leukotriene receptor antagonists, abx
Target O2 for children 6-11 - ANS ✔✔94%-98%
Target O2 for adults - ANS ✔✔96%
,Is intermittent or continuous nebs better? - ANS ✔✔Neither (conflicting data)
Key takeaways for asthma exacerbation - ANS ✔✔Albuterol, inh ipratropium, and oral or IV
steroids reduce complications and hospitalization rates
Key takeaways COPD - ANS ✔✔Abx are indicated for vented patients or ones who meet criteria
based on cardinal symptoms but abx should only be for 5-7 days.
Key takeaways CAP - ANS ✔✔Abx is based on comorbidities, severity, and risk factors for PA and
MRSA
Best approach for post-intubation analgesia and sedation - ANS ✔✔IV bolus therapy for acute
needs prior to increasing infusion rates
Ipratropium key points - ANS ✔✔Not monotherapy, with albuterol it improves bronchodilator
effect. Reduces rates of admission in pts with severe obstruction of airflow (esp kids) no benefit
after hospitalization
Systemic Corticosteroids in asthma - ANS ✔✔Improved lung fct., reduced hospitalization, lower
rate of relapse after discharge, oral and IV equally effective. Higher doses do not have more
efficacy and carry more risk.
Mag Sulfate - Asthma - ANS ✔✔2g IV over 20 min. Helps in kids, maybe adults. Improved lung
fct. Reduced rates of hospitalization in kids and maybe severe adults.
Steroid dose for asthma - ANS ✔✔Prednisone 1mg/kg/day oral max 50mg. Or prednisone 40-80
mg/day oral, Or adults hydrocortisone 500mg/dose oral or methylprednisolone 125mg/dose IV
or IM kids 1-2 mg/kg/day of prednisolone/prednisone oral 40mg max.
, Cardinal symptoms of COPD - ANS ✔✔Cough increased in frequency/severity. Increased sputum
volume or change of character. Dyspnea increased.
Causes of COPD exacerbations - ANS ✔✔Viruses, bacterial infections, environment (pollution or
temp)
Rule outs for COPD exacerbation (differential DX) - ANS ✔✔Pna, pleural effusion, pulmonary
edema, pneumothorax, PE, cardiac dysthymia
Treatment of mild COPD exacerbation - ANS ✔✔Short acting bronchodilators (can be controlled
with increase in regular meds)
Treatment of moderate COPD exacerbation - ANS ✔✔Short acting bronchodilator, oral steroids,
oral abx
Treatment of severe COPD exacerbation - ANS ✔✔ED and/or hospitalization
Presentation of non-life-threatening acute respiratory failure COPD - ANS ✔✔RR>30, accessory
muscle use, requires Venturi mask at 24-35% FiO2, increase in PaCO2
Presentation of life threatening acute resp failure COPD - ANS ✔✔RR >30, accessory muscle
use, acute change in mental status, >40% FiO2, PaCO2 >60 mmHg or pH<7.25
Risk factors for COPD exacerbation - ANS ✔✔Concomitant asthma, allergic phenotypes, high
degree of inflammation, past exacerbation, chronic bronchitis
COPD exacerbation mgmt - ANS ✔✔Resp support, inhaled b2 agonists+/-short acting
anticholinergics, systemic corticosteroids, abx if indicated
