Chronic obstructive pulmonary disease exacerbation resident survival guide: Difference between revisions
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==Management== | ==Management== | ||
{{Family tree/start}} | {{Family tree/start}} | ||
{{Family tree | | | | A01 | | | |A01= '''COPD Exacerbation''' | {{Family tree | | | | A01 | | | |A01= '''COPD Exacerbation'''<br>↑cough, ↑dyspnea, ↑sputum, <br> ↑wheezing, fever or chest tightness}} | ||
{{Family tree | | | | |!| | | | | }} | {{Family tree | | | | |!| | | | | }} | ||
{{Family tree | | | | B01 | | | |B01=Admission}} | {{Family tree | | | | B01 | | | |B01=Admission}} | ||
{{Family tree | | | | |!| | | | |}} | {{Family tree | | | | |!| | | | |}} | ||
{{Family tree | | | | C01 |~| C02 | |C01='''Assessment''' :1-O2 sat +ABG 2-CXR 3-EKG 4-CBC | {{Family tree | | | | C01 |~| C02 | |C01='''Assessment''' :<br>1-O2 sat +ABG <br>2-CXR <br>3-EKG <br>4-CBC | ||
<br> | |||
'''Management:''' <br>1-Inhaled bronchodilators <br>2-Systemic corticosteroids <br>3-Empirical antibiotics <br>4-O2 (target Sat >90%)| C02=tahseen }} | |||
'''Management''' | |||
{{Family tree | | | | |!| | | | |}} | {{Family tree | | | | |!| | | | |}} | ||
{{Family tree | | | | D01 | | | |D01= | {{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}} | |||
Severe dyspnea | |||
{{Family tree | | |,|-|^|-|.| | }} | {{Family tree | | |,|-|^|-|.| | }} | ||
{{Family tree | E01 | | |E02 |E01=No | E02= Yes}} | {{Family tree | E01 | | |E02 |E01=No | E02= Yes}} | ||
{{Family tree | |!| | | |!| |}} | {{Family tree | |!| | | |!| |}} | ||
{{Family tree | F01 | | |F02|F01=Continue the same management |F02=ICU Admission '''NIV''' }} | {{Family tree | F01 | | |F02|F01=Continue the same management |F02='''ICU Admission''' <br>'''NIV''' }} | ||
{{Family tree | | | | | |!| |}} | {{Family tree | | | | | |!| |}} | ||
{{Family tree | | | | | |G01 |G01= Unable to | {{Family tree | | | | | |G01 |G01= Unable to tolerate NIV? | ||
Sever hemodynamic instability? | Sever hemodynamic instability? | ||
Resp/Cardiac arrest ? }} | Resp/Cardiac arrest ? }} | ||
Revision as of 21:21, 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?
(Accessory muscles use, paradoxical motion of abdomen, retraction of intercostal space | |||||||||||||||||||||
| No | Yes | ||||||||||||||||||||
| Continue the same management | ICU Admission NIV | ||||||||||||||||||||
| Unable to tolerate NIV?
Sever 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.