COP D: (acute) Flashcards
If pt becomes tachycardic while on albuterol, what do you do
Switch to levalbuterol
Treatment for COPD exacerbation while inpt
- SABA+/- SAMA
- Continue long acting brochodilator (or start on discharge if not on prior)
- Systemic glucocorticoid: 40mg prednisone 5D
- O2 therpay if pt O2 sat <90%
- ABX if pt has increased sputum purulence and one of the following
- increased dyspnea
- increased sputum volume
SABA/SAMA use in acute COPD inpt
- formulation (neb vs. inhaler device) does NOT matter
- give 1 dose Q1H for 2-3 doses then Q2-4H PRN
Benefit of systemic glucocorticoid in acute COPD
- improve oxygenation
- recovery time shorten hospitalzaion
- reduce risk of relapse
Target O2 sat in acute COPD
88-92%
If no improvement while on supplemental O2, pt will need mechanicla ventilation
What to monitor for when pt is on supplemental O2
- ABG - donn’t want hypercapnia
- For resp acidosis
- pH <7.3
- PaCO2 >45 mmHG
What ABX to use in an acute COPD pt with the following characteristics:
- Uncomplicated exacerbation
- <4 exacerbations / year
- No commorbidites
- zithro
- clarithromycin
- 2nd or 3rd gen cephalosporin
- doxy
What ABX to use in an acute COPD pt with the following characteristics:
- Complicated exacerbation
- > 4 exacerbations / year
- Age 65+
- Commorbidites
- augmentin
- levofloxacin
- gemifloxacin
- moxifloxacin
What ABX to use in an acute COPD pt with the following characteristics:
- High risk for MDR
- Chronic cortocosteroid therapy
- Hospitlazation in past 90 days
- ABX use in past 90 days
- LTC resident
- levofloxacin
- IV options: 3rd or 4th gen cephalosporin (cefepime, ceftazidime)
ABX to NEVER use in COPD exacerbation
- Erythromycin - doesn’t cover H. influenzae
- Bactrim - d/t resistance
- Amoxicillin ad first gen cephalosporins (keflex) d/t beta lactamase susceptibility
ABX monitoring in COPD exacerbation
- WBC
- O2 requirements
- temp
- physical exam
- renal function (SCr, BUN)
- hypersensitivity
- c.diff infection
Pt monitoring in acute COPD exacerbation
- Temp, HR RR TID
- WBC, SCr, electrolytes
- S/Sx QD