Pulmonary - Stanford University
Definition. Hyperventilation. Non-pulmonary causes: metabolic acidosis, anxiety
Initial evaluation. Overall look, vital signs, O2 sat, lung exam, ABG, CXR, ancillary data (meds, WBC, EKG), comorbid conditions
• Red flags: looks tired, RR 40s, O2 sat 95% in this patient population it may precipitate respiratory failure due to worsened V/Q mismatch, the Haldane effect on the Hb-CO2 dissociation curve, and decreased respiratory drive.
• Albuterol 2.5/5 cc q1-2h during the acute phase is the first line of treatment. As symptoms improve, may switch to less frequent regimen (albuterol nebs q4h with albuterol q2h PRN)
• Ipratropium (Atrovent) nebulizer 0.5 mg q4-6h along with albuterol has been demonstrated to have a synergistic effect in improving airflow during COPD flares.
• Corticosteroids have been demonstrated to have a role in decreasing morbidity in patients with COPD flares. A high dose would be Solu-Medrol 125 mg IV q6h x 24-48h and then switch to prednisone 60 mg PO qd. Taper prednisone dose according to improvement in symptoms and airflow movement during physical exam.
• Antibiotics may have a role in treatment of infection causing flares or shortening the hospital stay in those without obvious infections. A trial of azithromycin 250 mg PO qd x 5 d and/or a second/third generation cephalosporin (cefuroxime/ceftriaxone) is reasonable.
• The role of theophylline on acute COPD flares is controversial.
• Trial of BiPAP, consider in patients who have decrease in level of consciousness, mental status changes, RR >30 and ABG with pO2 ................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.