copd and respiratory failure Flashcards
what to give in acute breathlessness in COPD
Steroids Nebulised bronchodilators Oxygen and target sats prescription VTE prophylaxis Antibiotics Sputum culture
COPD exacerbation types
Infective or non-infective
COPD exacerbation infection symptoms
Increased SOB
Increased sputum volume
Increased sputum purulence
What other symptoms can you have with COPD exacerbations
Wheeze/cough
Ankle oedema
Confusion/drowsiness
Investigations to do in copd exacerbation
CXR
ABG (don’t need to do if sats more than >94% on air and if they’re not drowsy or confused)
ECG
FBC
Sputum MC&C
Blood cultures (only do if they’re pyrexial)
Initial management of copd exacerbation
Bronchodilator use (SABA via spacer if well enough otherwise give via nebuliser air driven)
Prednisolone 30mg daily for 7 days
When to use abx
If have 2 or more of
Increased sputum volume
Colour change
Increasing breathlessness
When to give Abx for CAP or copd exacerbations
Don’t treat copd exacerbations with CAP protocols unless there is consolidation on CXR
How to choose pharmacological management
First use their FEV1FVC ratio and then use their mMRC score (A are those with mild COPD symptoms and D is the worst) to figure out a pharmacological management.
What count is responsive to steroids
High eosinophil count
What other comborbidities do those with COPD have
IHD Mental health Osteoporosis Bronchiectasis/astham Low BMI
When is long term oxygen therapy used
HOw often
pO2<7.3
Po2>7.3 <8 plus polycythaemia or cor pulmonale
Use at least 15h / day
Other oxygen therapies
Ambulatory oxygen (when walking around0 Short burst (as required)
Surgical COPD treatment for advanced
One way valve to allow air back out and collapse down
Surgical lung volume resection
Lung transplant
what is acute hypercapnia respiratory failure
-Presentstion?
Medical emergency
-AKA type 2 resp failure
-Problem is with ventilation therefore PaO2<8 and paCo2 >6
What is minute ventilation
-Formula?
The total volume breathed in and out over a minute in L
resp rate X tidal volume
How does minute ventilation correspond to PaCo2
Higher minute ventilation the lower the CO2
What can cause hypercapnia respiratory failure
Anything that reduces your RR or your tidal volume over time
- Pathology that affects brainstem
- morbid obesity
- Congenital chest disorders or scoliosis
- Muslce disorders as can affect diaphragm (MND, Guillain Barre)
- Severe lung disease
Blood gas of those with acute hypercapnia respiratory failure
Low pH
Raised Co2
Low Po2
Normal HCo3
Blood gas of those with chronic hypercapnic respiratory failure
Normal pH
raised Co2
Low O2
High HCo3
Blood gas of those with chronic hypercapnic respiratory failure
Low pH
Raised co2 more than their baseline
Low O2
High HCo3
Management of Acute hypercapnic resp failure
Medical Management Ventilatory support (either non invasive or invasive) whilst medical management is working
How does ventilation work
Improves chest expansion
Increased tidal volume
Increase minute ventilation
Lowers CO2 and improve oxygenation
When can you use non invasive ventilation acutely
When can’t you
YEs
- COPD
- chest wall disorder
- Neuromuscular disorder
No
- asthma
- Pneumonia
- Pulmonary oedema
What is Co2 narcosis
Group of people are o2 sensitive- when given O2 to correct their hypoxia, their Co2 rises
-Does not mean they have COPD. Anyone at risk of acute hypercapnic resp failure can develop co2 narcosis
What sats should you do an ABG
if sats 94% on air
If sats are 94% o2 and co2 <6, what o2% should you aim for
Unless?
94-98
Unless they’ve had previous history of hypercapnic resp failure
