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| {{familytree/start}}
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| {{familytree | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | |A01=<div style="float: left; text-align: left; line-height: 150%; ">'''Characterize the symptoms:''' <br> ❑ Increased cough <br> ❑ Increased Dyspnea <br> ❑ Increased sputum production <br> ❑ Wheezing </div>}}
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| {{familytree | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | B01 | | | | | | | | | | | | | | |B01=<div style="float: left; text-align: left; line-height: 150% ">'''Examine the patient:''' <br> ❑ [[Pulse oximetry]] <br> ❑ [[Arterial blood gas]] </div> }}
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| {{familytree | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | C01 | | | | | | | | | | | | | | |C01=<div style="float: left; text-align: left; line-height: 150%; ">'''Consider alternative dagnosis:''' <br> ❑ [[Pulmonary embolism]] <br> ❑ [[Heart failure]] <br> ❑ [[Asthma]] exacerbation <br> ❑ [[Bronchiectasis]] <br> ❑ Broncholitis obliterans </div>}}
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| {{familytree | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | D01 | | | | | | | | | | | | | | |D01=<div style="float: left; text-align: left; line-height: 150%; ">'''Supplement Oxygen: (Urgent)''' Maintain SaO<sub>2</sub> ≥ 88-92% </div>}}
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| {{familytree | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | E01 | | | | | | | | | | | | | | |E01=<div style="float: left; text-align: left; line-height: 150%; ">'''Need for ICU admission?''' <BR> ❑ Hemodynamic instability AND/OR <BR> ❑ Changes in mental status (confusion, lethargy, coma) AND/OR <BR> ❑ Severe dyspnea that responds inadequately to initial emergency therapy AND/OR <BR> ❑ Worsening hypoxemia (Pa<sub>O<sub>2</sub></sub> <40 mm Hg) and/or respiratory acidosis (pH <7.25) </div> }}
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| {{familytree | | | | | | | |,|-|-|-|-|-|^|-|-|-|-|-|.| | | | | | | | | |}}
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| {{familytree | | | | | | | F01 | | | | | | | | | | F02 | | | | | | | | |F01=No |F02=Yes}}
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| {{familytree | | | | | | | |!| | | | | | | | | | | |!| | | | | | | | | |}}
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| {{familytree | | | | | | | G01 | | | | | | | | | | G02 | | | | | | | | |G01=<div style="float: left; text-align: left; line-height: 150% ">'''Indications for Hospitalization:''' <br><BR> ❑ Marked increase in intensity of symptoms (eg, sudden development of resting dyspnea) <BR> ❑ Presence of serious comorbidities (eg, heart failure or newly occurring arrhythmias) <BR> ❑ Failure of an exacerbation to respond to initial medical management <BR> ❑ Onset of new physical signs (eg, cyanosis, peripheral edema) <BR> ❑ Severe underlying COPD (GOLD 3—4 categories) <BR> ❑ Frequent exacerbations (≥2 events per year) <BR> ❑ Insufficient home support <BR> ❑ Older age (>65 years)
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| '''Assessment of Exacerbation:''' <br><BR> ❑ Cardinal symptoms (↑ dyspnea, ↑ sputum volume, and ↑ sputum purulence) <BR> ❑ ECG (identify coexisting cardiac problems) <BR> ❑ Chest radiograph (exclude alternative diagnoses)<BR> ❑ Whole-blood count (identify polycythemia, anemia, or leukocytosis) <BR> ❑ Electrolytes and glucose (identify electrolyte disturbances or hyperglycemia)</div> |G02=<div style="float: left; text-align: left; line-height: 150% "> ❑ Admit patient to ICU <br> ❑ Classify as Life-threatening COPD exacerbation <br> ❑ Assess patients need for mechanical ventilation </div> }}
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| {{familytree | | | | | | | |!| | | | | | | | |,|-|-|^|-|-|.| | | | | | |}}
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| {{familytree | | | | | | | |!| | | | | | | | H01 | | | | H02 | | | | | |H01=<div style="float: left; text-align: left; line-height: 150% ">'''Indications for Noninvasive Mechanical Ventilation''' <BR> ❑ Respiratory acidosis (arterial pH < 7.35 or Pa<sub>CO<sub>2</sub></sub> >45 mm Hg) <BR> ❑ Severe dyspnea with signs of respiratory muscle fatigue <BR> ❑ Increased work of breathing </div>
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| |H02=<div style="float: left; text-align: left; line-height: 150% ">'''Indications for Invasive Mechanical Ventilation''' <BR> ❑ Diminished consciousness, psychomotor agitation inadequately controlled by sedation <BR> ❑ Severe hemodynamic instability without response to fluids and vasoactive drugs <BR> ❑ Respiratory pauses with loss of consciousness or gasping for air <BR> ❑ Life-threatening hypoxemia in patients unable to tolerate NIV <BR> ❑ Persistent inability to remove respiratory secretions <BR> ❑ Heart rate <50/min with loss of alertness <BR> ❑ Severe ventricular arrhythmias <BR> ❑ Respiratory or cardiac arrest <BR> ❑ Failure of initial trial of NIV <BR> ❑ Massive aspiration</div>}}
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| {{familytree | | | | | | | |!| | | | | | | | |`|-|-|v|-|-|'| | | | | | |}}
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| {{familytree | | | | | | | |!| | | | | | | | | | | |!| | | | | | | | | |}}
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| {{familytree | | | | | | | |)|-|-|-|v|-|-|-|.| | | |!| | | | | | | |}}
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| {{familytree | | | | | | | |!| | | |!| | | |!| | | |!| | | | | |}}
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| {{familytree | | | | | | | |!| | | |!| | | |!| | | |!| | | | | |}}
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| {{familytree | | | | | | | I01 | | I02 | | I03 |-|-|'| | | | | |I01=<div style="float: left; text-align: left; line-height: 150% ">'''Mild Exacerbation''' (⊕ 1 cardinal symptom) <BR> ❑ Consider outpatient management <BR> ❑ Require change of inhaled treatment by the patient</div> |I02=<div style="float: left; text-align: left; line-height: 150% ">'''Moderate Exacerbation''' (⊕ 2 cardinal symptoms) <BR> ❑ Consider outpatient management <BR> ❑ Require a short course of antibiotics and/or oral corticosteroids </div>|I03=<div style="float: left; text-align: left; line-height: 150% ">'''Severe Exacerbation''' (⊕ 3 cardinal symptoms) <BR> ❑ Consider inpatient management <BR> ❑ Assess symptoms, ABG, and CXR <BR> ❑ Monitor fluid balance and nutrition <BR> ❑ Identify and treat associated conditions <BR> ❑ Consider subcutaneous heparin or LMWH <BR> ❑ Controlled oxygen therapy (consider NIV if indicated) <BR> ❑ Antibiotics (if ↑ sputum purulence or ⊕ bacterial infection) <BR> ❑ Corticosteroids <BR> ❑ Bronchodilators <BR> ▸ Increase doses/frequency of short-acting bronchodilators <BR> ▸ Combine short-acting β2-agonists and anticholinergics <BR> ▸ Use spacers or air-driven nebulizers </div>}}
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| {{familytree/end}}
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