Sandbox vidit5: Difference between revisions
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{{familytree | | | | | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | |A01=<div style="float: left; text-align: left; line-height: 150%; ">'''Characterize the symptoms:''' | {{familytree | | | | | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | |A01=<div style="float: left; text-align: left; line-height: 150%; ">'''Characterize the symptoms:''' | ||
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❑ Increased cough <br> ❑ Increased Dyspnea <br> ❑ Increased sputum production <br> ❑ Wheezing </div>}} | |||
{{familytree | | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}} | {{familytree | | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}} | ||
{{familytree | | | | | | | | | | | | | | | | | B01 | | | | | | | | | | | | | | |B01=<div style="float: left; text-align: left; line-height: 150% ">'''Examine the patient:''' | {{familytree | | | | | | | | | | | | | | | | | B01 | | | | | | | | | | | | | | |B01=<div style="float: left; text-align: left; line-height: 150% ">'''Examine the patient:''' | ||
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❑ [[Pulse oximetry]] <br> ❑ [[Arterial blood gas]] </div> }} | |||
{{familytree | | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}} | {{familytree | | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}} | ||
{{familytree | | | | | | | | | | | | | | | | | C01 | | | | | | | | | | | | | | |C01=<div style="float: left; text-align: left; line-height: 150%; ">'''Consider alternative dagnosis:''' | {{familytree | | | | | | | | | | | | | | | | | C01 | | | | | | | | | | | | | | |C01=<div style="float: left; text-align: left; line-height: 150%; ">'''Consider alternative dagnosis:''' | ||
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❑ [[Pulmonary embolism]] <br> ❑ [[Heart failure]] <br> ❑ [[Asthma]] exacerbation <br> ❑ [[Bronchiectasis]] <br> ❑ Broncholitis obliterans </div>}} | |||
{{familytree | | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}} | {{familytree | | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}} | ||
{{familytree | | | | | | | | | | | | | | | | | D01 | | | | | | | | | | | | | | |D01=<div style="float: left; text-align: left; line-height: 150%; ">'''Supplement Oxygen: (Urgent)''' Maintain SaO<sub>2</sub> ≥ 88-92% </div>}} | {{familytree | | | | | | | | | | | | | | | | | D01 | | | | | | | | | | | | | | |D01=<div style="float: left; text-align: left; line-height: 150%; ">'''Supplement Oxygen: (Urgent)''' <br> Maintain SaO<sub>2</sub> ≥ 88-92% </div>}} | ||
{{familytree | | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}} | {{familytree | | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}} | ||
{{familytree | | | | | | | | | | | | | | | | | E01 | | | | | | | | | | | | | | |E01=<div style="float: left; text-align: left; line-height: 150%; ">'''Need for ICU admission?''' <div class="mw-collapsible-content"> | {{familytree | | | | | | | | | | | | | | | | | E01 | | | | | | | | | | | | | | |E01=<div style="float: left; text-align: left; line-height: 150%; ">'''Need for ICU admission?''' <div class="mw-collapsible-content"> |
Revision as of 21:21, 18 December 2013
Characterize the symptoms:
❑ Increased cough ❑ Increased Dyspnea ❑ Increased sputum production ❑ Wheezing | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Consider alternative dagnosis:
❑ Pulmonary embolism ❑ Heart failure ❑ Asthma exacerbation ❑ Bronchiectasis ❑ Broncholitis obliterans | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Supplement Oxygen: (Urgent) Maintain SaO2 ≥ 88-92% | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Need for ICU admission? ❑ Hemodynamic instability AND/OR ❑ Changes in mental status (confusion, lethargy, coma) AND/OR ❑ Severe dyspnea that responds inadequately to initial emergency therapy AND/OR ❑ Worsening hypoxemia (PaO2 <40 mm Hg) and/or respiratory acidosis (pH <7.25) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
No | Yes | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Indications for Hospitalization: ❑ Marked increase in intensity of symptoms (eg, sudden development of resting dyspnea) ❑ Presence of serious comorbidities (eg, heart failure or newly occurring arrhythmias) ❑ Failure of an exacerbation to respond to initial medical management ❑ Onset of new physical signs (eg, cyanosis, peripheral edema) ❑ Severe underlying COPD (GOLD 3—4 categories) ❑ Frequent exacerbations (≥2 events per year) ❑ Insufficient home support ❑ Older age (>65 years) | Assessment of Exacerbation: ❑ Cardinal symptoms (↑ dyspnea, ↑ sputum volume, and ↑ sputum purulence) ❑ ECG (identify coexisting cardiac problems) ❑ Chest radiograph (exclude alternative diagnoses) ❑ Whole-blood count (identify polycythemia, anemia, or leukocytosis) ❑ Electrolytes and glucose (identify electrolyte disturbances or hyperglycemia) | ❑ Admit patient to ICU ❑ Classify as Life-threatening COPD exacerbation ❑ Assess patients need for mechanical ventilation | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Indications for Noninvasive Mechanical Ventilation ❑ Respiratory acidosis (arterial pH < 7.35 or PaCO2 >45 mm Hg) ❑ Severe dyspnea with signs of respiratory muscle fatigue ❑ Increased work of breathing | Indications for Invasive Mechanical Ventilation ❑ Diminished consciousness, psychomotor agitation inadequately controlled by sedation ❑ Severe hemodynamic instability without response to fluids and vasoactive drugs ❑ Respiratory pauses with loss of consciousness or gasping for air ❑ Life-threatening hypoxemia in patients unable to tolerate NIV ❑ Persistent inability to remove respiratory secretions ❑ Heart rate <50/min with loss of alertness ❑ Severe ventricular arrhythmias ❑ Respiratory or cardiac arrest ❑ Failure of initial trial of NIV ❑ Massive aspiration | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Mild Exacerbation (⊕ 1 cardinal symptom) ❑ Consider outpatient management ❑ Require change of inhaled treatment by the patient | Moderate Exacerbation (⊕ 2 cardinal symptoms) ❑ Consider outpatient management ❑ Require a short course of antibiotics and/or oral corticosteroids | Severe Exacerbation (⊕ 3 cardinal symptoms) ❑ Consider inpatient management ❑ Assess symptoms, ABG, and CXR ❑ Monitor fluid balance and nutrition ❑ Identify and treat associated conditions ❑ Consider subcutaneous heparin or LMWH ❑ Controlled oxygen therapy (consider NIV if indicated) ❑ Antibiotics (if ↑ sputum purulence or ⊕ bacterial infection) ❑ Corticosteroids ❑ Bronchodilators ▸ Increase doses/frequency of short-acting bronchodilators ▸ Combine short-acting β2-agonists and anticholinergics ▸ Use spacers or air-driven nebulizers | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||