Question

the patient comes to the emergency room with COPD. the patient shows signs of distress. the heart rate is 119 at rest, spo2 of 86% and pursed lip breathing. what would you do to help this patient

(therapeutic, medications, oxygen, etc.)

Answer 1

Acute exacerbation of COPD requires treatment with bronchodialators , oxygen , antibiotics , steroids and sometimes mechanical ventilation

Bronchodialators:-

Short acting beta agonist such as Salbutamol and muscarinic antagonist such as ipratropium bromide are used either separately or in combination. It is given as nebulization when patient is in respiratory distress. On discharge, metered dose inhalers are given.Methyl xanthines such as theophylline can also be added.Blood levels need to be monitored when giving methyl xanthines to avoid toxicity

Oxygen :-

Supplemental oxygen is given to maintain oxygen saturation above 90%

Antibiotics:-

COPD patients often have respiratory pathogens colonisation in the tract.Usual pathogens implicated are Streptococcus pneumoniae, Hemophilus influenzas,Moraxella catarrhalis,Mycoplasma pneumoniae. Antibiotic choice is made based on the local antibiotics susceptibility pattern and patient's condition

Mechanical ventilation:-

Non invasive positive pressure ventilation is given if PaCO2 is more than 45mm Hg.Invasive ventilation by intubation is needed if there is severe respiratory distress despite initial therapy, severe hypoxaemia, severe hypercarbia, respiratory arrest or hemodynamic changes

Steroids:-

Systemic glucocorticoids are found to decrease the length of hospital stay.30-40 mg prednisolone is advised during discharge

-Advise patient to avoid all pulmonary irritants such as smoking

-Give chest physiotherapy with postural drainage

-Advise increased fluid intake

-Advise vaccination against Pneumococci and Influenza