COPD patients vary widely, due to their comorbidities, social circumstances, and wishes. So choosing the best treatment pathway for the patient can be complex. Involve senior decision makers.
Questions
- Is hospital the best place for them?
- Do they need NIV?
- Are they dying? – would you want to die surrounded by strangers or with your family?
Investigations – ALL if Admission
- Blood gases – Think VBG vs ABG
- Chest X-ray
- ECG
- FBC/U&E + Theophylline level (if on theophylline).
- Sputum microscopy and culture (if purulent sputum)
- Blood Culture (if suspected sepsis)
Treatments
Will depend on the patient and severity of exacerbation
- Initial treatment for ALL: Neb. Controlled O2 and Steroids [<30mins]
- Antibiotics [if purulent sputum]
- Further treatment to Consider:
- Back to Back Nebs (Salbutamol and Ipratroprium)
- IV Aminophylline
- 5mg/kg bolus (30min) upto 500mg (if not on theophylline)
- Maintenance ONLY Aminophylline (post bolus / on theophylline)
- NIV – persisting respiratory acidosis
- Intubation?? (Often not suitable)
NIV – Guide HERE
Should be considered for all COPD patients with a persisting respiratory acidosis after a maximum of one hour of standard medical therapy
Discharge/Admission
This is frequently a difficult decision, with many medical and social influences. Information is key and utilise senior decision-making.
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