Sandbox/17

Assessment : 1-O2 sat+ ABG 2-CXR 3-EKG 4-CBC Management: 1-Inhaled bronchodilators 2-Systemic corticosteroids 3-Empirical antibiotics 4-O2 (target Sat >90%)

Corticosteroids(Solumedrol) Methylprednisolone 125 mg×1 dose followed with 60-80 mg Q8-12based on severity IV Solumedrol to PO Prednisone taper 4--60 mg Q 8-12 2-5 days taper depending on severity Antibiotics Group A* Doxycycline Cap Vibramycin PO 100 mg Q12H (if unable to tolerate choose Cefpodoxime Tab Vantin PO 200 mg Q12H) Group B* Ceftriaxone Inj Rocephin 1GM D5W50 ml Q24H 200 ml/Hr (If Beta-Lactam allergy choose Levofloxacin Tab LevaquinPO 500 mg daily ) Group C* Ciprofloxacin Tab CiproPO 250 Daily or Ciprofloxacin Inj Cipro 400 mg premixed at 400 mg /200 ml Q12H 200 ml/Hr.

Respiratory acidosis? OR PH≤35? OR PaCo2≥45? OR Severe signs of dyspnea? OR Accessory muscles use, paradoxical motion of abdomen, retraction of intercostal space

No

Yes

Continue the same management

ICU Admission NIV

Unable to tolerate NIV? Severe hemodynamic instability? Resp/cardiac arrest ?

Invasive mechanical ventilation

*Group A:mild exacerbation, no risk factors, 2>symptoms present Group B:Mod Exacerbation w/risk factors for poor outcomes:comorbid disease, severe COPD, Frequent exacerbation>3, Antimicrobial use within the last 3 months Group C:Severe exacerbation w/risk factors for P.aeruginosa infection.