FN: COPD acute exacerbations Flashcards Preview

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Flashcards in FN: COPD acute exacerbations Deck (10):
1

Causes

Viral URTI (30%)
Also bacterial infections

2

History

Smoking Status
Exercise capacity
Current treatment
Previous exacerbations

3

Investigations

PEFR
Bloods: FBC, U + E, ABG, CRP, cultures
Sputum culture
CXR: infection , pneumothorax
ECG

4

Differential

Pneumothorax
Pulmonary oedema
PE
Asthma

5

Management

1. Controlled oxygen therapy
2. Nebulied bronchodilators
3. Steroids
4. Abx
5. NIV if no response

6

Controlled oxygen therapy

• Sit up
• 24% O2 via Venturi mask: spO2 99-92%
• Vary FiO2 and SpO2 target according to ABG
• Aim for PaO2 >8 and increased PCO2 of <1.5 kPa

7

Nebulised Bronchodilators

• Air driven wih nasal specs
• Salbutamol 5mg/4h (SABAs)
• Ipratropium 0.5mg/6h

8

Steroids

• Hydrocortison 200mg IV
• Prednisolone 40mg PO

9

Abx

• If evidence of infection
• Doxy 200mg PO sat then 100mg OF PO for 5d

10

NIV if no response:

• Repeat nebs and consider aminophylline IV
• Consider NIV (BiPAP) if pH 30
• Consider invasive ventilation if pH7.26
• Depends on pre-morbid state: exercise capacity, home O2 comorbidity
• If evidence of infection
• Doxy 200mg PO sat then 100mg OF PO for 5d

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