Exacerbation of COPD
bronchospasm, mucosal oedema, ↑ sputum → ↑ dynamic hyperinflation
| Headline | |
|---|---|
| History | infective (H. influenzae, Strep pneumo), pollutants. More common in winter. |
| Examination | |
| Diagnostic investigations | |
| Differentials | Pneumothorax, PE, (cardiogenic) pulmonary oedema, OHS (! - especially if not wheezy), resp depression e.g. from opioid toxicity Overlap with asthma or bronchiectasis |
| Immediate management | - Neb bronchodilators - Try to choose abx that patient hasn't had recently -- COPD patients probably colonised? - NIV/HFNO over invasive ventilation ➥ BTS: pH <7.35 and PaCO2 >6.5kPa → start NIV within 1h if appropriate ➥ Start low e.g. 15/3 → titrate to RR initially - Over-oxygenation risk lies in V-Q matching with pulmonary vasodilation...? |
| Ongoing management |
the intubated copd patient
- Difficult decision that everyone would like to avoid
- May be needed with multiorgan failure
- Lung protective ventilation - avoid autoPEEP