An acute reduction in respiratory function in a COPD sufferer, usually due to a infection.
Generally happen in winter and triggered by viral or bacterial infection. COPD sufferers have what are officially referred to as 'crappy lungs' or 'crappy lung syndrome'.
(Remember, these are all from what's normal for that person. If they can't get up stairs but they never could anyway, it doesn't really matter.)
- Peak flow (if you can)
- CXR - excludes pneumothorax or infection
- Blood cultures (with fever)
- Sputum culture
- ABC: 24% O2 guided by ABG. Aim for PaO2 >8kPa. Rise of PaCO2 <1.5kPa.
- Nebulised bronchodilators: salbutamol 2.5mg/4h + ipratropium 500 micrograms/6h + salbutamol 2.5mg as required (basically, you can give them loads of it.
- Steroids: oral prednisolone 30mg (IV hydrocortisone, if nil by mouth or prednisolone contraindciated)
- If infection use antibiotics (amoxicillin 500mg/8h po)
- If no response: aminophylline
- If still no response
- NIPPV (non-invasive positive pressure ventilation) where RR>30 or pH<7.35
- Consider intubation & ventilation pH <7.26/PaCO2 rising
- Consider doxapram 1.5-4mg/min iv (respiratory stimulant) where mechanical ventilation unsuitable