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 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 }}
'''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
}}
{{Family tree | | | | |!| | | | |}}
{{Family tree | | | | |!| | | | |}}
{{Family tree | | | | D01 | | | |D01=Respiratory acidosis? OR <br> PH≤35? OR<br> PaCo2≥45? OR<br> Severe signs of dyspnea? OR <br>(Accessory muscles use, <br>paradoxical motion of abdomen,<br> retraction of intercostal space}}
{{Family tree | | | | D01 | | | |D01=Respiratory acidosis? OR <br> PH≤35? OR<br> PaCo2≥45? OR<br> Severe signs of dyspnea? OR <br>(Accessory muscles use, <br>paradoxical motion of abdomen,<br> retraction of intercostal space}}

Revision as of 22:39, 25 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]:

  1. Worsening cough
  2. Increasing dyspnea
  3. 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


Management:
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
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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
 

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.