COPD

Question 1

in COPD there is airflow abnormalities such as…

Answer 1

-increased goblet cells
- mucus gland enlargement
- damage and scarring of the lying tissue
- airway narrowing

Question 1

COPD is characterised by….

Answer 1

airflow obstruction that is not fully reversible

Question 2

what is bronchitis

Answer 2

inflammation of the bronchial tubes of the lungs

Question 3

why dose chronic bronchitis occur

Answer 3

exposure to irritants in the lumen leads to hypertrophy and increased cell production of the goblet cells increasing mucus production in the brooch and brochures, leading to gas trapping and hyper mucus production

Question 4

exposure to irritants also damages the cilia leading too

Answer 4

them beckoning less mobile and shorter, increasing the secretion of mucus

this leads to a chronic productive cough

Question 5

presentation of bronchitis

Answer 5

wheeze (narrow airway)\
crackles (popping open of the airway)
low SP02 and higher C02
Pulmonary HTN

Question 6

what happens in ephasema

Answer 6

an inflammatory response due to exposure to irritants that leads a breakdown in the structural wall of the alveoli leading to a loss of elasticity

Question 7

what happens when the alveoli loose elasticity

Answer 7

when exhalling there is a low pressure system, without the elasticity, the alveoli collapse during exhalation and balloon during inhalation leading to gas trapping

Question 8

symptoms of emphysema

Answer 8

dysponea
pursed lips breathing (stops lungs from collapsing)
weight loss
hypoxemia
barrel chest ( gass trapping and hyperinflation )

Question 9

mild to moderate treatment

Answer 9

1.Follow the patient’s COPD action plan if they have one.

2.Administer bronchodilators using neb or MDI

02 as required
4.Administer 40 mg of prednisone PO.

Consider the likelihood that transport may not be required if the patient rapidly improves with bronchodilators via an MDI or following one dose of nebulised bronchodilators.

Question 10

severe treatment

Answer 10

1.Administer bronchodilators using neb

02 as required
IVA
An ICP or CCP may administer midazolam in 0.5 mg doses IV, sparingly for severe anxiety.
Administer 10 mmol (2.47 g) of magnesium IV over approximately 15 minutes
6.Consider application of CPAP if the patient is not improving.

The administration of an oral steroid is not a priority but should occur if the patient is able to swallow, using the doses described above.

Question 11

life threatening treatment

Answer 11

Administer adrenaline IV in addition to the treatments for severe COPD: (1 mg of adrenaline into a 1 litre bag of 0.9% sodium chloride)
1.Administer bronchodilators using neb

02 as required
IVA
Administer 10 mmol (2.47 g) of magnesium IV over approximately 15 minutes
6.Consider application of CPAP if the patient is not improving.
DO NOT GIVE MIDAZ

Question 12

when to get backup

Answer 12

Backup from an ICP/CCP should be requested if the patient has severe anxiety or imminent respiratory arrest.

Question 13

Personnel may recommend that a patient with mild to moderate COPD is not transported to a medical facility by ambulance, provided

Answer 13

Known COPD, and

Improves to their usual respiratory state, and
An SpO2 greater than or equal to 88%

Observed by personnel for a minimum of 20 minutes following completion of the last bronchodilator administration, and

Observed to mobilise in a way that is normal for the patient, and

Able to see an appropriate healthcare professional within two days, and

Provided with a prednisone pack (if indicated and available), and an information sheet with the contents clearly explained to the patient and to any carers.
If the patient has signs of a chest infection (for example fever or purulent sputum), the patient should be seen by an appropriate healthcare professional within 12 hours. This should usually be in a primary care facility if all of the other non-transport criteria are met.

Question 14

mild/moderate presentation

Answer 14

are short of breath, able to speak in sentences, moving enough air to generate wheeze, usually have some chest and/or neck indrawing, have an SpO2 that is near their normal level and a normal level of consciousness.

Question 15

severe presentation

Answer 15

very short of breath, usually only able to speak a few words with each breath, may not be moving enough air to generate wheeze, usually have severe chest and/or neck indrawing, may be in the tripod position, may have an SpO2 that is significantly below their normal level and may have agitation.

Question 16

life threatening presentation

Answer 16

extremely short of breath, usually unable to speak, may not be moving enough air to generate wheeze or to have chest and/or neck indrawing, usually have a rapidly falling SpO2 and usually have severe agitation and/or a falling level of consciousness.

Question 17

Patients at high risk of hypercarbia include

Answer 17

patients with COPD, morbid obesity, those on home oxygen and those on home CPAP or BiPAP.

Question 18

the signs of a rising carbon dioxide level are usually

Answer 18

confusion, drowsiness, agitation and a falling level of consciousness. If a patient is suspected of developing hypercarbia, oxygen administration should not be discontinued immediately. Instead, oxygen administration should be reduced to a lower flow rate (targeting an SpO2 of 88-92%) and the patient reassessed.

Question 19

Consider assisting the patient’s ventilation early using a manual ventilation bag and mask if:

Answer 19

SpO2 continues to fall below 80% despite treatments, or
The patient is becoming exhausted, or
The patient is suspected of developing hypercarbic respiratory failure despite lowering the oxygen flow.

Question 20

differentiating between CPO and COPD

Answer 20

Cardiogenic pulmonary oedema is the likely diagnosis when the patient has been supine (for example in bed) and the wheeze is worse bilaterally in the lower zones. The patient is often hypertensive, clammy and peripherally vasoconstricted.

COPD is the likely diagnosis if it is associated with a productive cough and the wheeze is evenly heard through all lung fields. The patient is usually normotensive and not peripherally vasoconstricted.

Question 21

steps of prednisone pack admin

Answer 21

a
If the patient has known COPD and is not transported, a prednisone pack should be provided unless the patient already has an action plan for administering their own steroid.

Provide an information sheet, ensuring the information is explained to the patient and any carers.
The pack contains a supply of prednisone, and this is usually sufficient for a complete course of prednisone.

However, it is important to advise the patient to be seen in primary care for a review of their treatment within two days.

Question 22

The decision to administer adrenaline must include weighing up the potential benefits against the potential risks which include

Answer 22

Adrenaline may result in bronchodilation, but it may also cause tachydysrhythmias and myocardial ischaemia. Patients with COPD are at very high risk of the adverse effects of adrenaline and this is why it is reserved for imminent respiratory arrest.