Sick COPD scenario
candidate brief
You have been asked to examine a patient in the corridor as the nurse is worried they look more unwell after treatment. Mdm Leong has been in the department for about 2 hours in the corridor with exacerbation of COPD. She has received nebulisers, steroids and oxygen.
actor brief
You are a 72yo with COPD. You have had a cough/cold for the last 4 days but today you were much more breathless than usual.
PMH: AF, COPD - 1x hospital attendance previously for IECOPD, no ICU
DHx: tiotropium, symbicort,
Fully independent, cognitively intact
examiner brief
Febrile, tachycardic, tachypneic
Recognise silent chest + obtunded as becomes more hypercapnic
ABG - pH 7.14, pCO2 8, pO2 6.5, HCO3 32, BE +4, lac 3
pCO2 and pH improves with some
- Introduces self, confirms patient identify, Washes hands
- Clarifies team competencies
- Moves patient to appropriate area
- Takes handover and appropriate history
- A/B – applies oxygen, ABG
- Recognise respiratory failure on ABG
- Recognise need for NIV
- C – IV access, cultures and bloods inc VBG
- Gives fluid bolus of 500ml crystalloid and re-assess
- Considers hydrocortisone
- D – GCS, Lateralising signs
- E – ?
- Checks medications, allergy status
- Appropriate treatment - nebs, steroids
- Asks for collateral history
- Functional baseline and establish appropriate escalation status
- Plans for disposition of patient - decision for critical care
- Plans for central access, further investigations, inotropes
- Leads Team well
- Plans for further appropriate investigations
source(s)
based on a real patient!