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Exacerbation of COPD
- worsening of previously stable
- increasing wheeze, dyspnoea, sputum volume, sputum purulence
- chest tightness
- fluid retention
Investigation
- FBC
- U&E
- CXR
- SaO2 / ABG
- PEF / FEV1
- Sputum
- ECG / Echo
Treatment
- controlled O2 therapy
- monitor ABGs and reduce if pCO2 rising
- Nebulised beta2-agonist 2-4 hourly+ ipratropium
- consider IV aminophylline if no response
- antibiotics (if increased breathlessness, sputum)
- amoxil 500mg tds
- augmentin 625mg tds
- clarithromycin 500mg BD
- IV augmentin / ceftriaxone
- oral steroids if responsive
- IV rehydration
- ventilation if
- clear basis for deterioration
- first episode of respiratory failure
- acceptable quality of life before
- not previously had full medical assessment
- few co-morbidities
- physiotherapy
- before discharge
- smoking cessation
- FEV1 / FVC
- ABG
- Education / inhaler technique
- ?social services
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