GP- COPD Flashcards
What are duty doctors’ roles in a GP practice?
It is often part of their duty to ensure that the right patients are seen at the right time.
The role often involves seeing ‘emergencies’ if they happen at the practice e.g. someone turning up acutely short of breath without an appointment or seeing people ‘on the day’.
3They might also phone people requesting home visits, to see if their problem can be solved over the phone, which is more time efficient than a GP going to visit, and allows the practice to see more people.
For acute exacerbations of COPD, when should you consider hospital admission?
- Severe breathlessness, rapid onset of symptoms, acute confusion, cyanosis, worsening peripheral oedema, or impaired consciousness.
- The person is unable to cope or lives alone.
- A reduction in activities of daily living, is confined to bed, or is on long-term oxygen therapy (LTOT).
- Significant comorbidity.
- Low oxygen saturation (less than 90%) on pulse oximetry.
What is the management of a COPD with low oxygen saturation?
o Give oxygen (if available) while awaiting transfer to hospital. Refer to local protocols or follow instructions on the person’s oxygen alert card if available. Otherwise, use a 28% Venturi mask at a flow rate of 4 L/min, and aim for an oxygen saturation of 88–92%.
o If the oxygen saturation remains below 88%, change to nasal cannulae at 2–6 L/min or a simple mask at 5 L/min with target saturation of 88–92%, and request an emergency ambulance.
o If the oxygen saturation decreases after starting oxygen therapy, change to a 24% Venturi mask at a flow rate of 2 L/min.
What is the hospital at home scheme?
Hospital-at-home and assisted-discharge schemes (where locally available) should be used as an alternative way of caring for people who would otherwise need to be admitted or stay in hospital. A community Matron) might be involved with these schemes, and is another example of how the GP practice meets the needs of its population.
What is done during a COPD review?
- Assessment of severity- use the MRC dyspnoea scale, FEV1 recordings, BMI- low BMI is associated with poor prognosis.
- Reinforcement of smoking cessation advice.
- Step up management- pharmacological treatment, inhaler technique, pulmonary rehabilitation.
- Review self-management.
Who does the COPD review?
Nurses
What is a rescue pack?
1) A rescue pack, also known as ‘rescue medication ’, is a supply of steroids to be started if the person with COPD notices increased shortness of breath affecting their activities of daily living (ADLs), or antibiotics if they have more or discoloured sputum.
What should the patient do if unsure about starting a rescue pack?
The person should be advised to seek medical attention if they start, or are unsure if they should start, medication and should have written information about this.
