COPD exacerbation
Medgeeks with Andrew Reid
Medgeeks
4.8 • 997 Ratings
🗓️ 13 December 2018
⏱️ 9 minutes
🧾️ Download transcript
Summary
Today, I want to review the evaluation and management of an acute COPD exacerbation.
We have a 65 year old obese male who's a former smoker of 30 years (1 pack/day), but quit 5 years ago.
He has a past medical history of COPD on 3L nasal canula, coronary artery disease, GERD, and type 2 DM.
He's presenting with a 3 day history of subjective fever, increasing cough, increasing sputum production, and shortness of breath.
On exam, he has bilateral wheezing.
First let's treat the vitals:
- fever = tylenol
- tachycardia = EKG and former EKG
- hypoxia = high flow oxygen first line
Now, that we've got the base down, we can start to manage the underlying cause: COPD exacerbation.
I'll walk you through every step of the way in today's podcast.
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Transcript
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| 0:00.0 | Team, we're back, Zach here for med geeks. So today, let's review evaluation and management |
| 0:07.4 | of acute COPD exacerbation. So this will be a little similar to the first to podcast I ever did approach to acute respiratory failure |
| 0:15.8 | where we're going to kind of hone in on COPD itself and the actual nitpicky management. |
| 0:21.6 | So you have a 65 year old obese male former |
| 0:25.2 | smoker of 30 years, one pack per day, quit five years ago. Past medical |
| 0:30.4 | history of COPD on three liters oxygen at baseline around the clock and per the |
| 0:35.4 | patient he's an internal Bi-PAP compliant, non-obstructive CAD GERD and |
| 0:41.4 | type 2 diabetes on long- acting insulin who presents with three day |
| 0:44.9 | history of subjective fevers, increasing cough, increasing sputum |
| 0:49.4 | production, which is green in color, and shortness of breath. |
| 0:52.6 | On exam, he has bilateral wheezing. |
| 0:55.4 | So big history questions you want to ask are any prior hospitalizations, |
| 1:00.2 | any prior steroid use, any intubations for the COPD exacerbations. |
| 1:05.0 | So first off, let's treat the vitals. |
| 1:08.0 | If they have a fever, you're given Tylenol. |
| 1:11.0 | If they have tachy, you get an E. G, get a prior E. G. What's the rhythm? |
| 1:16.8 | If sinus tack, don't treat, treat the underlying cause. If different rhythm, then treat. |
| 1:22.4 | Tachipnea and hypoxia. If different rhythm, then treat. |
| 1:23.0 | Tachipnea and hypoxia. |
| 1:25.0 | First trial, high flow oxygen for hypoxia in these COPD patients. |
| 1:29.0 | That extra kind of support helps out. |
| 1:31.0 | And if this doesn't work and the patient continues to display increased |
... |
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