Resp Copd Asthma

Question 1

copd what r th target o2 sats

Answer 1

When managing patients with COPD, once the pCO2 is known to be normal the target oxygen saturations should be 94-98%.

patients at risk of hypercapnia (e.g. COPD patients): 88-92% (see below)
oxygen should be reduced in stable patients with satisfactory oxygen saturation

Management of COPD patients
prior to availability of blood gases, use a 28% Venturi mask at 4 l/min and aim for an oxygen saturation of 88-92% for patients with risk factors for hypercapnia but no prior history of respiratory acidosis
adjust target range to 94-98% if the pCO2 is normal

Question 2

Management of moderate and high-severity community acquired pneumonia

Answer 2

dual antibiotic therapy is recommended with amoxicillin and a macrolide
a 7-10 day course is recommended
NICE recommend considering a beta-lactamase stable penicillin such as co-amoxiclav, ceftriaxone or piperacillin with tazobactam and a macrolide in high-severity community acquired pneumonia

Question 3

Management of low-severity community acquired pneumonia

Answer 3

amoxicillin is first-line
if penicillin allergic then use a macrolide or tetracycline
NICE now recommend a 5 day course of antibiotics for patients with low severity community acquired pneumonia

Question 4

NICE recommend that the following information is given to patients with pneumonia in terms of how quickly their symptoms should symptoms should resolve:

Time Progress for pneumonia

Answer 4

1 week Fever should have resolved
4 weeks Chest pain and sputum production should have substantially reduced
6 weeks Cough and breathlessness should have substantially reduced
3 months Most symptoms should have resolved but fatigue may still be present
6 months Most people will feel back to normal.

Question 5

Discharge criteria and advice post-discharge

NICE recommend that patients are not routinely discharged if in the past 24 hours they have had 2 or more of the following findings:

Answer 5

temperature higher than 37.5°C
respiratory rate 24 breaths per minute or more
heart rate over 100 beats per minute
systolic blood pressure 90 mmHg or less
oxygen saturation under 90% on room air
abnormal mental status
inability to eat without assistance.