COPD exacerbation and NIV Flashcards

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1
Q

What is an excerbation of COPD?

A
  • Acute episodes
  • Sustained worsening of COPD symptoms
    • eg. dyspnoea; cough; sputum
  • Beyond normal day-to-day variations
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2
Q

Name two triggers for exacerbations of COPD

A
  • Respiratory tract infections
    • Most commonly rhinovirus
  • Smoking
  • Environmental pollutants
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3
Q

Give three symptoms of an exacerbation of COPD

A
  • Worsening:
    • Dyspnoea
    • Cough
    • Sputum production; change in colour
  • Other:
    • Increased wheeze; chest tightness
    • URT symptoms: eg. cold; sore throat
    • Reduced exercise tolerance
    • Ankle swelling
    • Fatigue
    • Delirium
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4
Q

Provide two features suggestive of a severe exacerbation of COPD

A
  • Marked dyspnoea and tachypnoea
  • Pursed-lip breathing; use of accessory muscles at rest
  • New-onset cyanosis; peripheral oedema
  • Delirium; drowsiness
  • Marked reduced in ADLs
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5
Q

Request four investigations for an acute exacerbation of COPD

A

All acute exacerbations presenting to hospital:

  • CXR
  • ABG
  • ECG: exclude comorbidities
  • FBC; U+E; CRP
  • Theophylline level: if on theophylline therapy
  • Sputum microscopy/culture: if purulent
  • Blood cultures: if pyrexic
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6
Q

Outline the management of exacerbations of COPD

A
  1. Salbutamol 5mg/4h + ipratropium 500mcg/6h
  2. O2 as needed: high flow, then titrate to target levels
  3. 30mg PO prednisolone or 200mg IV hydrocortisone for 5/7
    • Consider PPIs and bisphosphonates
  4. Chest physiotherapy: aid sputum expectoration
  5. Consider
    • IV aminophylline
      • Frequent monitoring
    • NIV
    • ITU for invasive ventilation

Consider need for antimicrobials eg. amoxicillin

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7
Q

What are the indications for acute non-invasive ventilation?

A
  • COPD: either
    • pH <7.35; pCO2 >6.5; RR >23
    • Persisting after bronchodilator and controlled O2 therapy
  • Neuromuscular disease: either
    • Respiratory illness w/ RR >20 if usual VC <1L
    • pH <7.35 and pCO2 >6.5
  • Obesity: either
    • pH <7.35; pCO2 >6.5; RR >23
    • Daytime pCO2 >6.0 and somnolent
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9
Q

Give three contraindications for non-invasive ventilation

A
  • Severe facial deformity
  • Facial burns
  • Fixed upper airway obstruction
  • pH <7.15
  • GCS <8
  • Confusion; agitation
  • Cognitive impairment
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10
Q

Outline the discharge planning following exacerbation of COPD

A
  • Spirometry prior to discharge
  • Re-establish optimal maintenance bronchodilators
  • Satisfactory SaO2/ABG if episode of respiratory failure
  • Medication review and education
  • Consider follow-up and home care
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