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COPD (Dx: PFT low FEV1/FVC low FEV1 no reversability (Tx: SABA prn,…

- - - - Dx:
        
        CXR
        
        ABG
        
        EKG
        (all rule outs)
        
        :warning:CXR (flattened diaphragm) not specific for emphysema
        
        :warning: ABG shows high CO2, but not useful for COPD diagnosis
        
        :warning: EKG won't show anything
        
        Tx: Abx
        
        Doxycycline :bicyclist:
        
        Azithromycin (long QT risk)
        
        Everyone needs:
        Bronchodilators
        
        albuterol or metered dose inhalers
        
        ipratroprium if severe
        
        Steroids
        
        PO (prednisone)
        
        IV (methylprednisolone) if severe
        
        Monitor for response
        
        O2 (88-92%)
        
        duonebs (albuterol/ipratroprium) q30min
        
        steroids
        
        :check:Gets better
        
        1 more item...
        
        :green_cross:Gets worse
        
        rising CO2
        
        confusion
        
        absence of wheese/lung sounds
        
        1 more item...
        
        :green_cross:Needs more time
        
        pt gets admitted to the floor (wards)
        
        1 more item...
  - - - add LABA (-olol)
        
        add ICS
        
        add PDE4 inhibitor
        
        add steroids
        
        :pencil2:We are ok to give LABA w/o ICS in COPD
    - - Corticosteroids (in order of severity)
        
        ICS
        
        PO steroids
        
        IV steroids
        
        O2
        
        SPO2 < 88%, PaO2 <55
        
        excretion or at rest
        
        Goal : 88-92%
        
        :pencil2:Goal not 100%, COPD pts need hypoxic drive to keep breathing. In intubated patient, 100% O2 will be hard to remove ventilator.
        
        give O2 in acute setting
        
        scale back to 88-92%
        
        Prevention
        
        Influenza shot /year
        
        PNA shot <65yo. >65yo (1x before and after)
        
        smoking cessation :no_smoking:
        
        :pencil2:smoking cessation :no_smoking: and O2 are the only things that improve mortality
        
        Dilators
        
        short acting (tiotropium/albuterol)
        
        long acting (LAMA/LABA)
        
        orals (Theophylline/PDE4i)
        
        Rehab
        
        improves exercise capacity, not mortality