Acute COPD

Question 1

What A-E does this affect?

Answer 1

Breathing

Question 2

Airway

Answer 2

Question 3

Breathing

Answer 3

Look: uneven chest expansion, tripoding, accessory muscle use
Listen: crackles (?infection), wheeze, consolidation
Feel: percussion, tracheal deviation

O2, RR

ABG
* lactate
* Type II resp failure

/ CXR to exclude infective exacerbation

Management:

15L O2 via NRM
* If ABG shows high bicarb ie patient is CO2 then and SaO2< 88%
* CONTROLLED OXYGEN: 24-28% O2 via venturi mask aiming for 88-92%

Nebulised salbutamol:
* 5mg / 4hours
* Nebulised ipratropium bromide 0.5 mg/ 6 hours

Steroids:
* Iv hydrocortisone 200 mg (or oral pred 50mg)

Amoxicillin
* follow Trust guidelines (amoxicillin 500mg/8 hours)

If no response to treatment -> Escalate to ICU!
* IV Aminophylline
* NIPPV - Repeat ABG:guide further O2, NIV (BiPAP) if pH <7.35 despite adequate oxygen
* Sputum culture
* CXR
* Intubation and ventilation

Question 4

Circulation

Answer 4

Look: anaemia, JVP (RH strain)
Listen: murmurs, lung sounds
Feel: CRT, BP, HR

ECG
Blood: FBC, UEs, LFTs, CRP

Question 5

Exposure

Answer 5

Check if calf swelling
Abdo exam
Catheter
Rashes
Drug chart

Question 6

Overall management

Answer 6

Definitive Ix:

Repeat ABG:guide further O2, NIV (BiPAP) if pH <7.35 despite adequate oxygen
Sputum culture
CXR

Question 7

Infective exacerbation of COPD