RRAPID: Acute Exacerbation of COPD

Question 1

Signs and symptoms? (5)

Answer 1

Increasing dyspnoea (SOB) and cough
Reduced exercise tolerance
Tachypnoea
Cyanosis
Wheeze

Question 2

Causes? (bacterial)(3) Others (3)

Answer 2

Step pneumonia
H.influenza
Moraxella Catarhallis (occasionally)

Smoking!
Alpha-1 antitrypsin deficiency

Question 3

Response (Airway)?

Answer 3

Sit patient up

Controlled O2 therapy

Question 4

What are the targets O2 sats? Delivered using which mask?

Answer 4

First line: 15 L O2 non-rebreath
88-92%
Venturi mask (adjust O2 concentrations accordingly)

Question 5

Response (Breathing)?

Answer 5

ABG

Chest X-ray

Question 6

ABG results?

Answer 6

PaO2 low, PaCO2 high - type II respiratory failure

Raised bicarbonate - if metabolic compensation)

Question 7

Response (Circulation)?

Answer 7

IV access (fluids PRN) & bloods: FBC, U&E’s, glucose
Blood/sputum cultures
ECG (for evidence of cor pulmonale)

Question 8

Medication Mx? (3)

Answer 8

Salbutamol 5mg NEB (4 hrly)

Ipratropium Bromide 500 mcg NEB (6 hrly)

Hydrocortisone 200 mg IV or Prednisolone 40 mg PO (7-14 days)

Question 9

What can be given if evidence of infection? If allergic?

Answer 9

Antibiotics (Amoxicillin/co-amoxiclav)

Allergy: doxycline

Question 10

Indications for non-invasive ventilation (NIV)? (4)

Answer 10

COPD with respiratory acidosis (pH 7.25 - 7.35)
Hypercapnic respiratory failure secondary to chest wall deformity (scoliosis, thoracoplasty) or neuromuscular diseases
Cardiogenic pulmonary oedema unresponsive to CPAP
Weaning from tracheal intubation

Question 11

Main two methods of NIV?

Answer 11

CPAP (continuous positive airway pressure)

BiPAP (bilevel positive airway pressure)