Chronic obstructive pulmonary disease exacerbation resident survival guide: Difference between revisions
Jump to navigation
Jump to search
Gerald Chi (talk | contribs) mNo edit summary |
Gerald Chi (talk | contribs) m (→Management) |
||
| Line 36: | Line 36: | ||
{{Family tree |border=2|boxstyle=background: WhiteSmoke;|A1|A1=<div style="float: center; text-align: left; height: 6em; width: 12em; padding: 1em">'''COPD Exacerbation''' <BR> ❑ Cough ↑ <BR> ❑ Dyspnea ↑ <BR> ❑ Sputum ↑ </div>}} | {{Family tree |border=2|boxstyle=background: WhiteSmoke;|A1|A1=<div style="float: center; text-align: left; height: 6em; width: 12em; padding: 1em">'''COPD Exacerbation''' <BR> ❑ Cough ↑ <BR> ❑ Dyspnea ↑ <BR> ❑ Sputum ↑ </div>}} | ||
{{Family tree |!| | | | | |}} | {{Family tree |!| | | | | | | | | |}} | ||
{{Family tree |border=2|boxstyle=background:WhiteSmoke;|) | {{Family tree |border=2|boxstyle=background:WhiteSmoke;|)|B1|B1=<div style="float: center; text-align: left; height: 13em; width: 41em; padding: 1em">'''Indications for Hospital Assessment or Admission''' <BR> ❑ Marked increase in intensity of symptoms (eg, sudden development of resting dyspnea) <BR> ❑ Severe underlying COPD <BR> ❑ Onset of new physical signs (eg, cyanosis, peripheral edema) <BR> ❑ Failure of an exacerbation to respond to initial medical management <BR> ❑ Presence of serious comorbidities (e.g., heart failure or newly occurring arrhythmias) <BR> ❑ Frequent exacerbations <BR> ❑ Older age <BR> ❑ Insufficient home support</div>}} | ||
{{Family tree |!| |}} | {{Family tree |!| |}} | ||
{{Family tree |border=2|boxstyle=background:WhiteSmoke;|)|C1|C1=<div style="float: left; text-align: left; height: 13em; width: 36em; padding: 1em">'''Assessment of Exacerbation''' <BR> ❑ Pulse oximetry (for tracking and/or adjusting supplemental oxygen) <BR> ❑ Arterial blood gases (if acute or acute-on-chronic resp. failure is suspected)'''†''' <BR> ❑ Acid-base status (before initiating mechanical ventilation) <BR> ❑ Chest radiographs (to exclude alternative Dx) <BR> ❑ ECG (Dx of coexisting cardiac problems) <BR> ❑ Whole-blood count (to identify polycythemia, anemia, or leukocytosis) <BR> ❑ Empirical ABx (if ⊕ purulent sputum) <BR> ❑ Biochemical tests (electrolyte disturbances, hyperglycemia, etc.)</div>}} | |||
{{Family tree/end}} | {{Family tree/end}} | ||
'''†''' <small>''Pa<sub>O<sub>2</sub></sub> <60 mmHg with or without Pa<sub>CO<sub>2</sub></sub> >50 mmHg in ambient air''</small> | |||
==Do's== | ==Do's== | ||
Revision as of 05:35, 11 December 2013
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Abdurahman Khalil, M.D. [2]
Definition
- An exacerbation of COPD is an acute event characterized by a worsening of the patient’s respiratory symptoms that is beyond normal day-to-day variations and leads to a change in medication.[1][2][3]
- The diagnosis of an exacerbation relies exclusively on the clinical presentation of the patient complaining of an acute change of symptoms (baseline dyspnea, cough, and/or sputum production) that is beyond normal day-to-day variation.[4]
Causes
Life Threatening Causes
Include conditions which may result death or permanent disability within 24 hours if left untreated, and some of them may mimic and/or aggravate exacerbations:
Common Causes
- Respiratory tract infections (~½)
- Unknown (~⅓)
- Air pollutants
Differential Diagnosis
Management
COPD Exacerbation ❑ Cough ↑ ❑ Dyspnea ↑ ❑ Sputum ↑ | |||||||||||||||||||||
Indications for Hospital Assessment or Admission ❑ Marked increase in intensity of symptoms (eg, sudden development of resting dyspnea) ❑ Severe underlying COPD ❑ Onset of new physical signs (eg, cyanosis, peripheral edema) ❑ Failure of an exacerbation to respond to initial medical management ❑ Presence of serious comorbidities (e.g., heart failure or newly occurring arrhythmias) ❑ Frequent exacerbations ❑ Older age ❑ Insufficient home support | |||||||||||||||||||||
Assessment of Exacerbation ❑ Pulse oximetry (for tracking and/or adjusting supplemental oxygen) ❑ Arterial blood gases (if acute or acute-on-chronic resp. failure is suspected)† ❑ Acid-base status (before initiating mechanical ventilation) ❑ Chest radiographs (to exclude alternative Dx) ❑ ECG (Dx of coexisting cardiac problems) ❑ Whole-blood count (to identify polycythemia, anemia, or leukocytosis) ❑ Empirical ABx (if ⊕ purulent sputum) ❑ Biochemical tests (electrolyte disturbances, hyperglycemia, etc.) | |||||||||||||||||||||
† PaO2 <60 mmHg with or without PaCO2 >50 mmHg in ambient air
Do's
- Monitor fluid balance,nutrition and patient condition closely.
- Consider subcutaneous heparin or low molecular weight heparin.
- Treat associated conditions if exist(e.g., heart failure,arrhythmias).
Don'ts
- Spirometry is not recommended during an exacerbation because it can be difficult to perform and measurements are not accurate enough.
References
- ↑ Burge, S.; Wedzicha, JA. (2003). "COPD exacerbations: definitions and classifications". Eur Respir J Suppl. 41: 46s–53s. PMID 12795331. Unknown parameter
|month=ignored (help) - ↑ Celli, BR.; Barnes, PJ. (2007). "Exacerbations of chronic obstructive pulmonary disease". Eur Respir J. 29 (6): 1224–38. doi:10.1183/09031936.00109906. PMID 17540785. Unknown parameter
|month=ignored (help) - ↑ Rodriguez-Roisin, R. (2000). "Toward a consensus definition for COPD exacerbations". Chest. 117 (5 Suppl 2): 398S–401S. PMID 10843984. Unknown parameter
|month=ignored (help) - ↑ Vestbo, J.; Hurd, SS.; Agustí, AG.; Jones, PW.; Vogelmeier, C.; Anzueto, A.; Barnes, PJ.; Fabbri, LM.; Martinez, FJ. (2013). "Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary". Am J Respir Crit Care Med. 187 (4): 347–65. doi:10.1164/rccm.201204-0596PP. PMID 22878278. Unknown parameter
|month=ignored (help)