Episode 24: COPD and Pneumonia

Emergency Medicine Cases

Dr. Anton Helman

Education, Health & Fitness, Courses, Medicine, Science

4.7 • 602 Ratings

🗓️ 14 June 2012

⏱️ 76 minutes

🔗️ Recording | iTunes | RSS

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Summary

In this episode we have the continuation of our discussion on Respiratory Emergencies with Dr. Anil Chopra and Dr. John Foote. We discuss key clinical decisions in COPD assessment and management - how to assess for impending respiratory failure, how best to oxygenate the COPD patient, medication pearls and how best to approach intubating the COPD patient. We then review an approach to hemoptysis as well as tricks of the trade for managing massive hemoptysis. Many pearls of pneumonia work-up and management are detailed as well as how to make important disposition decisions.

Transcript

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0:00.0	Welcome to Emergency Medicine Cases.com.
0:05.3	I'm your host, Dr. Anton Hellman, bringing you Canada's brightest minds in emergency
0:09.7	medicine from EMC Studios in Toronto.
0:16.4	In this month's episode on Respiratory Emergencies Part 2, we have with us again Dr. Anil Chopra and Dr. John Foote.
0:24.7	Dr. Neil Chopra is an emergency physician at the University Health Network in Toronto and an assistant professor in the Department of Medicine at the University of Toronto.
0:33.0	He's the head and medical director of emergency medicine at the University Health Network.
0:37.8	Dr. John Foote is an emergency physician at Mount Sinai Hospital in Toronto,
0:41.7	an assistant professor at the University of Toronto.
0:44.8	He's the program director for the CCFPEM Emergency Medicine Fellowship Program at the University of Toronto.
0:51.6	So in the first part of our respiratory emergencies episode, we talked
0:55.5	about PE. Now we're going to talk about COPD. This is the case of a 56-year-old man with a history
1:02.0	of COPD who presents to your ED by ambulance with worsening dyspnea, cough, and increasing
1:08.2	purulent sputum production over the past three days.
1:12.0	He denies chest pain or fever.
1:14.2	On exam, his blood pressure is 133 over 86, pulse of 115, respiratory rate of 28, 02 sat of 99% on a non-re breather, and a temperature of 37.7.
1:27.9	He appears very slim, dyspneic, and using some accessory muscles, but is able to speak in sentences.
1:35.3	Auscultation of the chest reveals widespread expiratory weezes, but no crackles.
1:40.5	He has no cyanosis, JVD, or petal edema.
1:44.4	His COPD meds are tiatropium, sporeva, once daily, and salbutamol, which is ventilin in Canada,
1:51.6	which he's been taking every two hours.
1:54.6	He's also taking endapamide for hypertension and lipitor for high cholesterol.
1:59.4	He has no other medical conditions. His hospital records
	...

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