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COPD “Trying to Expire Not Expire”

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

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COPD “Trying to Expire Not Expire”

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  1. COPD“Trying to Expire Not Expire” Dr Esyld Watson HST Emergency Medicine

  2. Overview Background Definitions Case Pre-hospital ED initial management ED continued management Evidence Cardiac arrest

  3. Background • 3 million people UK • Most diagnosed late 50s • Predominantly caused by smoking • Airflow obstruction not fully reversible • No simple diagnostic test

  4. 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

  5. Case 999 call SOB 65 year old female known COPD Increasing SOB and cough 2/7 Can’t speak in sentences

  6. 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

  7. Case – Prehospital Management • A • Sit upright • High flow oxygen • B • Position, forced expiration • Nebulised salbutamol 5mg • Ipratropium 500mcg • Hydrocortisone 100-200mg IV

  8. Case – Prehospital Management • C • IV access • IV fluids • ECG monitoring • D • Monitor • E

  9. Where to Manage?

  10. Case – Arrival into ED • A • No longer talking • B • RR 36, Sp02 99% 15L • Poor AE little wheeze • Clinically no pneumothorax

  11. 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

  12. Case – Management in ED • A • Position • Consider NP airways - suction • B • Sit upright • CXR • ABG

  13. Case – Management in ED • C • ECG shows AF • Bloods and cultures taken as pyrexial • D • Monitor • E

  14. Arterial Blood Gases • pH 7.15 • pC02 14.5 • P02 12.1 • HCO3- 33 • BE 4 • Lactate 3.7

  15. ABG Interpretation • Are they hypoxic? • Are they acidotic or alkalotic? • Is it respiratory or circulatory? • Base and Bicarbonate?

  16. Arterial Blood Gases • pH 7.15 • pC02 14.5 • P02 12.1 • HCO3- 33 • BE 4 • Lactate 3.7

  17. Specific Therapies Nebulised bronchodilators Steroids Antibiotics Magnesium NIV

  18. Bronchodilators • Salbutamol • Short acting beta2 agonist • Smooth muscle relaxant • Reversal of bronchospasm • Remember partial effects in COPD • Ipratropium • Antimuscarinic bronchodilator

  19. Corticosteroids • Prednisolone • 30mg od 7-14 days • Hydrocortisone • 100 – 200 mg IV

  20. Antibiotics • Purulent sputum • Signs pneumonia • PO doxycycline

  21. Magnesium

  22. Non-Invasive Ventilation • Hypercapnic ventilatory failure • Clear ceilings care

  23. Questions

  24. Keep it simple ABCDE Reassess Hypoxia kills first! Summary

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