COPD

Question 1

RED FLAGS

Question 2

DIFFERENTIALS

Answer 2

• HF
• Cardiogenic APO
• AMI
• PE
• Pneumothorax
• Pleural effusion
• Pneumonia
• Airway obstruction
• Anaphylaxis

Question 3

PATHOPHYSIOLOGY

Answer 3

CAUSE
Chronic irritant exposure causing inflammation (smoking, fumes, gases, dust, pollution, weather changes). Acute exacerbation (AE): Mostly caused by viral infection than bacterial, 16% PE –> AE accelerates the decline in lung function.

Emphysema– chronic inflammation causes:
- Reduced surfactant production + destruction of alveoli septum –> increases alveolar airspace –> alveolar collapse on expirations –> worsening lung damage
- Scarring/fibrosis –> impairs elastic recoil –> reducing lung compliance –> increasing pulmonary dead space.

Bronchitis- begins in larger bronchi & progresses to smaller bronchi
- Goblet cell proliferation & hypertrophy –> excessive mucus production –> mucus plugging, impaired cilia function –> pathogen proliferation + pulmonary capillaries constrict & redirect as they are not detecting O2 from the alveoli –> pulmonary hypertension –> RVF.

Asthma –> bronchoconstriction overinflation/ air trapping.
V/p mismatch –> impairing gas –> chronic hypoxaemia & hypercarbia.

Question 4

COMPLICATIONS

Answer 4

• Hypoxic drive
• Polycythaemia –> thrombus formation –> prone to PE, stroke & AMI
• Congestive HF caused by pulmonary hypertension –> RVF (Core pulminale)
• Cachexia, Exercise intolerance.

Question 5

TREATMENT

Answer 5

Primary survey: DRAB: supplemental O2 (88-92%), NEB Salbutamol/Ipratropium (@ 6L). C: IV access + fluids (if BP requires, beware overloading). D: Hydrocortisone (IM 100mg). E: reassurance, minimal exertion, maintain normothermia.
CCP: CPAP (@ 8L), IV Salbutamol
Secondary Survey: Thorough RSA, CVA + reassessments.

Question 6

ROLE OF PARAMEDICS

Answer 6

Address hypoxaemia, manage to Pt’s. baseline, comfortability. Reduce anxiety  reduces metabolic demand.

Question 7

DEFINITIVE CARE

Answer 7

Treatment - Same as paramedic management + CPAP or BIPAP
Assessments/tests:
- Whole blood count: Inflammatory markers, increased WBCs, blood culture for sepsis, polycythaemia.
- Arterial blood gasses: acidosis, septic, hypokalaemia.
- Chest radiography: identify pneumonia, rule out pneumothorax/PE/other DDx.
- Sputum culture: identify viral/bacterial infection causing exacerbation  antibiotics if bacterial.
- Medication review: long term O2 therapy, addition of muscarinic receptor antagonist, corticosteroid.
- Education: stop smoking, about disease, how/when to use ventilator/meds.
- Risk stratification: spirometry, documentation for future reference & comparison to previous exacerbations.
- Action plan: pulmonary rehab, exercise therapy, dietitian, upcoming GP/in-home check-ups to monitor recovery from acute exacerbation.