acute COPD Flashcards
What is the management pathway of acute COPD?
1) nebulised salbutamol and ipratropium
2) O2 sats aim: 88-92%
3) IV hydrocortisone 200mg and PO prednisolone 30mg
4) amoxicillin 500mg/8h if infection (alternatively clarithromycin)
5) if no response: IV aminophylline
What is the management pathway of a primary pneumothorax?
SOB and/or rim of air >2cm on CXR?
Yes = aspiration. If aspiration fails = chest drain. If aspiration is successful, consider discharge
No = discharge and review in 2-4w
What is the management pathway of a secondary pneumothorax?
SOB or rim of air >2cm on CXR?
Yes = chest drain
SOB or rim of air 1-2cm on CXR?
Yes = aspiration. If aspiration fails = chest drain
If aspiration is successful = admit for 24h
No (<1cm) = admit for observation
What are the signs of a pneumothorax?
Reduced expansion
Diminished breath sounds
Hyper resonance to percussion
What is the primary test you should do in a tension pneumothorax?
Do not do a CXR as it will delay treatment
Request an expiratory film instead
What is the treatment of a tension pneumothorax?
Insert a large bore (14-16G) needle with a syringe, partially filled with 0.9% saline, into the 2nd intercostal space in the midclavicular line
Do this before requesting a CXR
Then insert a chest drain
Where is a chest drain inserted?
‘Safe triangle’
4-6th intercostal space, anterior to mid axillary line
What is the most common cause of pneumonia?
Streptococcus pneumoniae
Following a PE, what are the guidelines surrounding long term anticoagulation?
Either switch LMWH to a DOAC or warfarin
If LMWH is switched to warfarin, continue LMWH until INR >2
If the PE was provoked = 3m anticoagulation
If the PE was unprovoked = 3-6m
What is the management pathway of a large PE?
Oxygen if hypoxic
Morphine with anti-emetic if pain
Start LMWH/Fondaparinux
If BP low give 500mL bolus
Not haemodynamically unstable? = consider vasopressors e.g. dobutamine if persistent low BP
Haemodynamically stable? = consider thrombolysis
