COPD EXACERBATION Flashcards
(31 cards)
What are the three cardinal symptoms of a COPD exacerbation?
Increased dyspnea, increased sputum volume, and increased sputum purulence.
What is the most common trigger for COPD exacerbation?
Respiratory infections (viral or bacterial).
What vital signs might be abnormal in a patient with a moderate to severe COPD exacerbation?
Tachypnea, tachycardia, hypoxia (low SpO₂), possible fever.
What oxygen target saturation is recommended in COPD exacerbation?
88–92% to avoid CO₂ retention and acidosis.
Which two inhaled bronchodilators are the cornerstone of initial management?
Short-acting beta-agonist (e.g., salbutamol) and short-acting muscarinic antagonist (e.g., ipratropium).
What systemic therapy is indicated in most moderate-to-severe exacerbations?
Oral corticosteroids (e.g., prednisolone 30–40 mg/day for 5 days).
When are antibiotics indicated in COPD exacerbation?
: If patient has:
Increased sputum purulence or volume Increased dyspnea Or requires mechanical ventilation
What common pathogens should be covered when prescribing antibiotics?
Haemophilus influenzae,
Streptococcus pneumoniae,
Moraxella catarrhalis
: Name three common oral antibiotics used in COPD exacerbation.
Amoxicillin-clavulanate, doxycycline,
azithromycin.
What investigations are essential in the ER for COPD exacerbation?
Pulse oximetry,
ABG (if severe),
Chest X-ray, ECG,
CBC, CRP,
Electrolytes.
What findings on ABG suggest respiratory failure in COPD exacerbation?
Hypoxemia (↓PaO₂), hypercapnia (↑PaCO₂), and acidemia (↓pH).
When should intubation and mechanical ventilation be considered?
Severe acidosis,
Altered mental status,
Failure of NIV.
What is the role of chest X-ray in COPD exacerbation?
To rule out pneumonia, pneumothorax, or other acute pathology.
What are red flags suggesting need for hospital admission in COPD exacerbation?
Inability to cope at home, severe symptoms, hypoxia, cyanosis, confusion, comorbidities, frequent exacerbations.
When should non-invasive ventilation (NIV) be considered?
pH < 7.35 and PaCO₂ > 6.0 kPa (45 mmHg) despite initial therapy.
What are key differential diagnoses for acute dyspnea in a COPD patient?
Pneumonia,
Pneumothorax,
Pulmonary embolism,
Heart failure,
Asthma exacerbation.
How can you differentiate COPD exacerbation from pneumonia on presentation?
Pneumonia often has fever, localized chest signs (e.g. crackles), elevated WBC, and new infiltrate on chest X-ray.
When should you suspect pulmonary embolism in a COPD exacerbation?
Sudden worsening dyspnea, pleuritic chest pain, hemoptysis, or leg swelling — especially if disproportionate to clinical findings.
What factors predict poor prognosis in a COPD exacerbation?
Older age, frequent exacerbations, comorbidities (e.g. CHF), low BMI, respiratory acidosis, need for NIV, or ICU admission.
ABG shows: pH 7.30, PaCO₂ 60 mmHg, HCO₃ 28. How do you interpret this?
Respiratory acidosis with partial metabolic compensation (suggests ventilatory failure).
In a dyspneic COPD patient, what does a normal PaCO₂ suggest?
May indicate tachypnea with effective ventilation — monitor closely; can rapidly decompensate.
What are hospital admission criteria for COPD exacerbation?
Severe symptoms, hypoxia (<88%), hypercapnia, altered mental status, failure of outpatient therapy, comorbidities, or poor home support.
When should you switch from nebulizers to MDI + spacer?
Once patient stabilizes and can coordinate breathing, MDIs with spacer are equally effective and preferred for long-term use.
What are signs of NIV failure in COPD exacerbation?
Worsening pH/PaCO₂, declining GCS, persistent hypoxia, respiratory muscle fatigue, or inability to tolerate mask.
