Chronic obstructive pulmonary disease exacerbation resident survival guide: Difference between revisions
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'''Management:''' <br>1-Inhaled bronchodilators <br>2-Systemic corticosteroids <br>3-Empirical antibiotics <br>4-O2 (target Sat >90%)| C02=tahseen }} | '''Management:''' <br>1-Inhaled bronchodilators <br>2-Systemic corticosteroids <br>3-Empirical antibiotics <br>4-O2 (target Sat >90%)| C02=tahseen }} | ||
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{{Family tree | | | | D01 | | | |D01=Respiratory acidosis? <br>PH≤35?<br>PaCo2≥45? | {{Family tree | | | | D01 | | | |D01=Respiratory acidosis? <br>PH≤35?<br>PaCo2≥45?<br>Severe signs of dyspnea?<br>(Accessory muscles use, <br>paradoxical motion of abdomen,<br> retraction of intercostal space}} | ||
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Severe signs of dyspnea?<br>(Accessory muscles use, <br>paradoxical motion of abdomen,<br> retraction of intercostal space}} | |||
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{{Family tree | E01 | | | E02 |E01=No | E02= Yes}} | {{Family tree | E01 | | | E02 |E01=No | E02= Yes}} | ||
Revision as of 21:24, 25 November 2013
Overview
COPD exacerbation commonly caused by infections, should be recognized when anyone or more of the following appears acutly in chronic COPD patient[1]:
- Worsening cough
- Increasing dyspnea
- Increasing in sputum production more than the baseline for chronic COPD Pts[1]:.
Differential Diagnosis
- Asthma
- CHF
- PE
- ACS
- Pneumothorax
- Pneumonia
- Lobar atelectasis
Management
| COPD Exacerbation ↑cough, ↑dyspnea, ↑sputum, ↑wheezing, fever or chest tightness | |||||||||||||||||||||
| Admission | |||||||||||||||||||||
| Assessment : 1-O2 sat+ ABG 2-CXR 3-EKG 4-CBC
1-Inhaled bronchodilators 2-Systemic corticosteroids 3-Empirical antibiotics 4-O2 (target Sat >90%) | tahseen | ||||||||||||||||||||
| Respiratory acidosis? PH≤35? PaCo2≥45? Severe signs of dyspnea? (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 | |||||||||||||||||||||
References
- ↑ 1.0 1.1 Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P; et al. (2007). "Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary". Am J Respir Crit Care Med. 176 (6): 532–55. doi:10.1164/rccm.200703-456SO. PMID 17507545.