COPD

Question 1

What drugs and doses are administered in the COPD CPG?

Answer 1

• Salbutamol 10mg and Ipratropium Bromide 500mcg Neb

- Dexamethasone 8mg IV/Oral

Question 2

If you have an adequate response post drug admin in COPD what do you do?

Answer 2

• Titrate O2 flow to target SpO2 88-92%

- Consider low flow O2 - e.g. nasal prongs

Question 3

If you have an inadequate response to drug therapy in a COPD patient, what do you do?

Answer 3

• MICA can commence CPAP and assess for signs of deteriorating respiratory status or ventilation failure

Question 4

What do you do if despite treatment, the COPD patient deteriorates?

Answer 4

• Provide assisted ventilation with 100% FiO2, if inadequate tidal volume or RR
• MICA can consider ETT

Question 5

When should COPD be suspected?

Answer 5

Patient over 40 who has

• Smoking history
• Dyspnoea that is progressive, persistent and worse on exercise
• Chronic cough
• Chronic sputum production
• Family Hx of COPD

Question 6

How do you define Exacerbation of COPD

Answer 6

• increased dyspnoea
• increased cough
• increased sputum production
• complete removal of wheeze in these patients may not be possible due to chronic airway disease

Question 7

What are the indications for CPAP?

Answer 7

• SpO2 < 90% on RA
  OR
• SpO2 <95% on supplemental O2

Question 8

What are the indications for the removal of pre-hospital CPAP

Answer 8

Ineffective

• cardiac/respiratory arrest
• mask intolerance/patient agitation
• nil improvement after 1 hour of treatment

Vital signs

• HR < 50
• SBP < 90mmHg
• LOC or GCS <13
• decreasing SpO2

Active risk to patient

• loss of airway control
• copious secretions
• active vomiting
• paramedic judgement of clinical deterioration