Chronic obstructive pulmonary disease exacerbation resident survival guide: Difference between revisions
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{{Family tree | | | | C01 |~| C02 | |C01='''Assessment''' :<br>1-O2 sat+ ABG <br>2-[[CXR]] <br>3-[[EKG]] <br>4-[[CBC]] | {{Family tree | | | | C01 |~| C02 | |C01='''Assessment''' :<br>1-O2 sat+ ABG <br>2-[[CXR]] <br>3-[[EKG]] <br>4-[[CBC]] | ||
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'''Management:''' <br>1-Inhaled bronchodilators <br>2-Systemic corticosteroids <br>3-Empirical antibiotics <br>4-O2 (target Sat >90%)| C02='''Corticosteroids(Solumedrol)'''<br>Methylprednisolone 125 mg×1 dose <br> followed with 60-80 mg Q8-12based on severity <br> IV Solumedrol to PO Prednisone taper 4--60 mg Q 8-12<br> 2-5 days taper depending on severity<br> '''Antibiotics'''<br>'''Group A'''*<br>Doxycycline Cap '''Vibramycin''' PO 100 mg Q12H<br>(if unable to tolerate choose Cefpodoxime Tab '''Vantin''' PO 200 mg Q12H)<br>'''Group B'''*<br>Ceftriaxone Inj '''Rocephin''' 1GM D5W50 ml Q24H 200 ml/Hr<br>(If Beta-Lactam allergy choose Levofloxacin Tab '''Levaquin''' PO 500 mg daily )<br> '''Group C'''*Ciprofloxacin Tab '''Cipro'''PO 250 Daily <br>or Ciprofloxacin Inj Cipro 400 mg premixed at 400 mg /200 ml Q12H 200 ml/Hr. | '''Management:''' <br>1-Inhaled bronchodilators <br>2-Systemic corticosteroids <br>3-Empirical antibiotics <br>4-O2 (target Sat >90%)| C02='''Corticosteroids(Solumedrol)'''<br>Methylprednisolone 125 mg×1 dose <br> followed with 60-80 mg Q8-12based on severity <br> IV Solumedrol to PO Prednisone taper 4--60 mg Q 8-12<br> 2-5 days taper depending on severity<br> '''Antibiotics'''<br>'''Group A'''*<br>Doxycycline Cap '''Vibramycin''' PO 100 mg Q12H<br>(if unable to tolerate choose Cefpodoxime Tab '''Vantin''' PO 200 mg Q12H)<br>'''Group B'''*<br>Ceftriaxone Inj '''Rocephin''' 1GM D5W50 ml Q24H 200 ml/Hr<br>(If Beta-Lactam allergy choose Levofloxacin Tab '''Levaquin''' PO 500 mg daily )<br> '''Group C'''*<br>Ciprofloxacin Tab '''Cipro'''PO 250 Daily <br>or Ciprofloxacin Inj Cipro 400 mg premixed at 400 mg /200 ml Q12H 200 ml/Hr. | ||
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'''Group A'''*:mild exacerbation, no risk factors, 2>symptoms present | '''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 | '''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. | '''Group C'''*:Severe exacerbation w/risk factors for P.aeruginosa infection. | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 15:20, 26 November 2013
Definition
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]
Causes
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
Common Causes
Differential Diagnosis
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%) | 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 Levaquin PO 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.
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.