ALTERNATIVE MEDICINE

Managing COPD Exacerbation

Managing COPD Exacerbation

Introduction

The patient, David Jones, is diagnosed respiratory distress associated with exacerbation of COPD.  After onset of treatment is determined gas control and observed correction of hypoxemia and increased respiratory acidosis. On examination, blood pressure is 150/90 mm Hg, heart rate of 98 /minute and respiratory rate of 32/minute.  The temperature was 37.2 o C, SpO2 89% and a GCS score of 15. Blood gas on admission, breathing air showed a PO2 of 8.1 kPa, PCO2 of 7.9kPa and pH 7.31. David was already treated 28% oxygen, nebulised bronchodilator, ipratropium bromide and intravenous prednisolone. After three hours his condition worsens with the PAR score of 5. After reviewed by the outreach team it was decided to transfer the HDU for for further management accompanied by the A&E nurse. Initially, david will be managed with teh ABCDE (Airways, Breathing, Circulation, Disability and Exposure) approach followed by the Nn-invasive ventilation alternative.

Discussion

Earlier COPD Management

Early diagnosis and effective treatment of chronic obstructive pulmonary disease (COPD) has the potential to improve the quality of life of patients and reduce the frequency of hospitalization and mortality. Acute exacerbation of COPD is a cause for frequent consultation in the emergency department (McIvor, 2002, pp. 19-31). An exacerbation is a sustained deterioration in symptoms usual and stable patient, who corresponds to a variation different from normal variations from day to day, and its appearance is acute (MacNee, pp. 247-257). The most common symptoms corresponding to an increase in respiratory distress, cough, increased sputum production, and a change in the sputum colour. These symptoms usually changes require a change in the patient's medications (Rodríguez-Roisin, 2006, pp. 535-544). In addition, patients with severe COPD are exposed to three specific problems: 1) hyperventilation causing acute respiratory alkalosis, 2) the occurrence of pulmonary and cardiovascular complex interactions that can lead to severe hypotension, and 3) the creating a positive pressure of end-tidal (intrinsic PEEP), termed "auto-PEEP" in connection with the dynamic lung hyperinflation, which can be particularly high if the duration of the expiration is insufficient (NHS, 2004, pp. 7-22). Therefore, such a decision will be made after carefully informing the patient by the doctor about the state of his health, ideally with family.

ABCDE Approach

Evaluation of airway

It is common for patients with acute emergency situations assisted in presenting a complete obstruction of the airway, as per the aspiration of the bolus, but it is quite common the presence of a partial obstruction of the airway (McIvor, 2002, pp. 19-31). The most common cause of this type of obstruction is the decreased level of consciousness. In this situation, not only is compromised ventilation efficiency but also the patient is vulnerable to pulmonary aspiration. Handling is difficult, so it is necessary to seek urgent anaesthesiologists help. Meanwhile, nurse must make a single opening operation of the airway (e.g. jaw thrust forward or chin lift), carefully aspirate oropharyngeal secretions, removing any foreign body (if accessible), and consider the use of oropharyngeal airway.

Evaluation of Breathing

Most of the evaluation of ...