COPD “Trying to Expire Not Expire”
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COPD “Trying to Expire Not Expire” Dr Esyld Watson HST Emergency Medicine
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COPD “Trying to Expire Not Expire”. Dr Esyld Watson HST Emergency Medicine. Overview. Background Definitions Case Pre-hospital ED initial management ED continued management Evidence Cardiac arrest. Background. 3 million people UK Most diagnosed late 50s - PowerPoint PPT Presentation
Transcript of COPD “Trying to Expire Not Expire”
COPD“Trying to Expire
Not Expire”
Dr Esyld WatsonHST Emergency Medicine
Overview Background Definitions Case Pre-hospital ED initial management ED continued management Evidence Cardiac arrest
Background 3 million people UK Most diagnosed late 50s Predominantly caused by smoking Airflow obstruction not fully
reversible No simple diagnostic test
Definition No recognised definition Consider
– Over 35 AND– Smoker or ex-smoker AND– Any
Exertional SOB Chronic cough Regular sputum Frequent winter “wheeze”
– And do not have asthma
Case 999 call SOB 65 year old female known COPD Increasing SOB and cough 2/7 Can’t speak in sentences
Case – Prehospital Assessment A
– Talking one or two words at time B
– RR 30, Sp02 77% OA, wheeze throughout C
– HR 110 irreg, BP 187/98 D
– GCS 14/15 (E3,V5,M6), BM 10.9 E
– Nil of note
Case – Prehospital Management
A– Sit upright– High flow oxygen
B– Position, forced expiration– Nebulised salbutamol 5mg– Ipratropium 500mcg– Hydrocortisone 100-200mg IV
Case – Prehospital Management
C– IV access– IV fluids– ECG monitoring
D– Monitor
E
Where to Manage?Treat at home? Treat in hospital?
Able to cope at home? Yes No
SOB Mild Severe
General condition Good Poor/deteriorating
Level of activity Good Poor/confined bed
Cyanosis No Yes
Worsening peripheral oedema
No Yes
Level of consciousness Normal Impaired
Already on LTOT No Yes
Social circumstances Good Living alone/not coping
Acute confusion No Yes
Rapid rate of onset No Yes
Significant co-morbidity
No Yes
Sa02 < 90% No Yes
Changes on CXR No Present
Arterial pH level ≥ 7.35 < 7.35
Arterial Pa02 ≥ 7 kPa < 7kPa
Case – Arrival into ED A
– No longer talking B
– RR 36, Sp02 99% 15L– Poor AE little wheeze– Clinically no pneumothorax
Case – Arrival in ED C
– HR 136 irreg, BP 178/98– Large volume radial pulse– Clammy
D– GCS 11/15 (E2V4M5), BM 10.1– T 38.1
Case – Management in ED A
– Position– Consider NP airways - suction
B– Sit upright– CXR– ABG
Case – Management in ED C
– ECG shows AF– Bloods and cultures taken as pyrexial
D– Monitor
E
Arterial Blood Gases pH 7.15 pC02 14.5 P02 12.1 HCO3- 33 BE 4 Lactate 3.7
ABG Interpretation Are they hypoxic? Are they acidotic or alkalotic? Is it respiratory or circulatory? Base and Bicarbonate?
Arterial Blood Gases pH 7.15 pC02 14.5 P02 12.1 HCO3- 33 BE 4 Lactate 3.7
Specific Therapies Nebulised bronchodilators Steroids Antibiotics Magnesium NIV
Bronchodilators Salbutamol
– Short acting beta2 agonist– Smooth muscle relaxant– Reversal of bronchospasm– Remember partial effects in COPD
Ipratropium– Antimuscarinic bronchodilator
Corticosteroids Prednisolone
– 30mg od 7-14 days Hydrocortisone
– 100 – 200 mg IV
Antibiotics Purulent sputum Signs pneumonia PO doxycycline
Magnesium
Non-Invasive Ventilation Hypercapnic ventilatory failure Clear ceilings care
Summary Keep it simple ABCDE Reassess Hypoxia kills first!
