Acute COPD Management Flashcards
COPD Exacerbation Features
Increase in cough, wheeze, dyspnoea
Increase in sputum (suggests infection)
May be hypoxic, may have acute confusion
Common bacterial organisms for infective exacerbations
High School Musical
- Haemophilus Influenza
- Streptococcus Pneumoniae
- Moraxella Catarrhlis
Viral exacerbations
~30% of exacerbations
Human rhinoviruses
Acute COPD Management
OSIP
O2 Venturi Mask 24-28%
Salbutamol Nebulised
Ipatropium Nebulised
Prednisolone Oral 30mg for 5 days
Regular ABGs and Ax
https://www.youtube.com/watch?v=LiNPaWOp8t0&list=PLmPwwVBSERt1XncL7fEIxaGCwmWQgpMME&index=11
When to give Antibiotics
If sputum is purulent and signs of pneumonia
Which Antibiotics to give
One of the following:
Amoxicillin
Clarithromycin
Doxycycline
When to consider NIV
pH 7.25- 7.35
COPD patients benefit the most from NIV
Action to take if NIV fails
Worsening pH/RR
Request urgent anaesthetic review for ?intubation
NIV Set Up
By nurse or physiotherapist
ABG before and after
CXR recommended but should not delay
LTOT Ax
8 weeks after exacerbation
Repeat ABG must be done
LTOT indications
PaO2 ≤ 7.3 kPa
OR
PaO2 ≤ 8kPA + secondary polycythaemia, pulmonary HTN, peripheral oedema
Acute COPD management summary plan
O2
Nebulised Salbutamol/Ipatropium
Prednisolone 30mg OD 5 days
Amoxicillin, Clarithromycin, Doxycycline if purulent sputum/pneumonia
Persistent Hypercapnia -> NIV (BiPAP)
If BiPAP fails, urgent anaesthetist review
Acute COPD investigations
Investigate to exclude other causes:
- ECG
- CXR
- Bloods = cardiac enzymes, eosinophils, CrP, U+Es, theophylline
- CT Chest
Acute COPD investigations to gauge severity
ABGs
O2 sats
Sputum and Blood Cultures
Acute COPD differentials
Pneumonia Pneumothorax PE Ca Heart Failure/ACS
