COPD (acute exacerbation)

Question 1

Formal diagnosis requires two out of three of which of the following?

A) Increase SOB, temperature, cough
B) Increased SOB, temperature, wheeze
C) Increased SOB, increased volume of sputum, increased purulence of sputum
D) Increased SOB, increased volume of sputum, temperature
E) Hypoxia, tachycardia, respiratory acidosis

Answer 1

C) Increased SOB, increased volume of sputum, increased purulence of sputum

Patients may present with a variety of symptoms. However, formal diagnosis of COPD exacerbation requires two of the following:

1) Increased shortness of breath
2) Increased sputum production
3) Increased purulence of sputum

Question 2

Which of the following is not a good marker of the severity of COPD?

A) Number of cigarettes smoked
B) Use of LTOT
C) Past use of NIV
D) Exercise tolerance
E) Number of exacerbations per year

Answer 2

A) Number of cigarettes smoked

Smoking increases risk of COPD, but number of cigarettes is not a good marker of COPD severity.

Question 3

A COPD patient looks unwell and has a resp rate of 33/min. You are concerned she might be deteriorating towards respiratory arrest. What is the correct initial oxygen therapy?

A) 2L via nasal cannla
B) 15L via non-re-breather
C) 24% venturi mask
D) 28% venturi mask
E) 6L via simple face mask

Answer 3

B) 15L via non-re-breather

Any patient that is peri-arrest or critically unwell should be placed on 15L via non re-breathe mask.

Question 4

What are the reference ranges for the common ABG findings?

Answer 4

pH: 7.35-7.45
pCO2: 4.5-6
pO2: 10-12
HCO3: 18-24
BE: -2 to +2
Lactate: <2

Question 5

How is COPD acute exacerbation managed?

Answer 5

1) Nebulisers
- Salbutamol 2.5mg QDS and PRN
- Ipratropium bromide 0.5mg QDS

2) Steroids
- Prednisolone 30mg od PO
- Hydrocortisone 100mg QDS if they can’t tolerate oral pred

3) Antibiotics (if infective cause)

4) Oxygen (target sats)
- Consider NIV/mechanical ventilation

5) Consider level of care (HDU/ICU?) and DNACPR, if appropriate.