Chronic obstructive pulmonary disease exacerbation resident survival guide

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Overview

COPD exacerbation commonly caused by infections, should be recognized when anyone or more of the following appears acutly in chronic COPD patient[1]:

  1. Worsening cough
  2. Increasing dyspnea
  3. Increasing in sputum production more than the baseline for chronic COPD Pts[1]:.

Differential Diagnosis

  1. Asthma
  2. CHF
  3. PE
  4. ACS
  5. Pneumothorax
  6. Pneumonia
  7. Lobar atelectasis

Management

 
 
 
COPD Exacerbation↑cough↑dyspnea↑sputum or ↑wheezing ,fever or chest tightness
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Admission
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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%)
 
tahseen
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Resp acidosis? PH≤35?,PaCo2≥45


Severe dyspnea signs?(Accessory muscles use ,paradoxical motion of abdomen ,retraction of intercostal space
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No
 
 
Yes
 
 
 
 
 
 
 
 
 
Continue the same management
 
 
ICU Admission NIV
 
 
 
 
 
 
 
 
 
 
 
 
 
Unable to telorate NIV?

Sever hemodynamic instability?

Resp/Cardiac arrest ?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Invasive mechanical ventilation
 

References

  1. ↑ 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.
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