COPD - Acute/Infective Exacerbation

Question 1

Causative Organisms of COPD IE (4).

Answer 1

1. H. influenze (commonest).
2. S. pneumoniae.
3. M. catarrhalis.
4. Viruses (30%) - RSV.

Question 2

Medical Management at Home (3).

Answer 2

1. Prednisolone 30mg once daily for 7-14 Days.
2. Regular Treatment.
3. Antibiotic - if bacterial infection.

Question 3

Medical Management at Hospital (4).

Answer 3

1. Steroids e.g. 200mg Hydrocortisone or 30-40mg Oral Prednisolone.
2. Nebulised Bronchodilators.
3. Oral Antibiotics - Infection (AMD) if Purulent.
4. Physiotherapy - Sputum.

Question 4

Advanced Management at Hospital (4).

Answer 4

1. IV Aminophylline.
2. NIV = BiPAP.
3. Intubation and Ventilation.
4. Doxapram (Respiratory Stimulant).

Question 5

Why should too much Oxygen detrimental to an IE of COPD patient? (2)

Answer 5

1. Depression of Respiratory Drive.
2. Slowed Breathing Rate and Effort - CO2 retention.

Question 6

How is Oxygen Therapy given in COPD?

Answer 6

Venturi masks - deliver a specific percentage concentration by leaking out side of the mask and normal air to be inhaled too.

Question 7

Types of Venturi Masks (6).

Answer 7

1. Blue - 24%.
2. White - 28%.
3. Orange - 31%.
4. Yellow - 35%.
5. Red - 40%.
6. Green - 60%.

Question 8

What are the targets in COPD Oxygen Therapy?

Answer 8

1. If CO2 retaining, aim for Oxygen saturations of 88-92% by Venturi Mask.
2. If not CO2 Retaining, Oxygen for SpO2 > 94%.

Question 9

How is a CO2 Retainer identified?

Answer 9

Bicarbonate is elevated - compensation.