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COPD EXACERBATION, SEEK SPECIALIST ADVICE :silhouettes:, NOT REQUIRING…

- - - - Lives alone, or cannot cope at home
        
        Poor/deteriorating general condition or significant co-morbidities. cardiac, IDDM
        
        Confusion/drowsy
        
        Rapid onset symptoms
      - Worsening odoema
        
        New arrhythmia
        
        Failure to respond to tx
        
        Already on LTOT
        
        Changes on CXR
      - give o2 while waiting, target 88 - 92%
        
        use their o2 alert card. Otherwise initially give via a Venturi 24% mask at 2-3 l/min or Venturi 28% mask at a flow rate of 4 l/min or nasal cannula at a flow rate of 1-2 l/min (if a 24% mask is not available).**
- - - - Send a sputum sample if symptoms not improved following antibiotic treatment and this has not already been done
      - Consider
        
        Other possible diagnoses, such as pneumonia.
        
        Previous antibiotic use which may have led to resistant bacteria.
        
        The need for admission.
        
        Symptoms or signs suggestive of a more serious illness or condition, such as cardiorespiratory failure or sepsis.
- - - - Severity of symptoms (particularly sputum colour changes and increase in volume or thickness beyond normal).
      - Risk of complications.
      - Previous sputum culture and susceptibility results.
      - Risk of antimicrobial resistance and current antibiotic prophylaxis (treatment should be with an antibiotic from a different class).
      - Amoxicillin 500 mg TDS for 5 days.
        
        Doxycycline 200 mg on first day, then 100mg OD for 5-days total
        
        Clarithromycin 500 mg BD for 5 days.
      - If no improvement in 2-3 days; guided by susceptibility and where admission is not indicated:
        
        Send a sputum sample for MCS
        Offer an alternative first choice antibiotic from a different class (guided by susceptibilities
        
        If at higher risk of treatment failure (ie frequent antibiotic use; previous or current sputum culture with resistant bacteria or high risk of developing complications) consider co-amoxiclav 500/125 mg TDS for 5/7
        
        Review the choice of antibiotic when results are available.
        Only change the antibiotic according to susceptibility results if bacteria are resistant and symptoms are not improving
      - Advise on adverse effects
        
        diarrhoea
        
        seek urgent help if rapidly worsening symptoms, no improvement in 2-3 days or feeling very unwell
        
        If NO ANTIBIOTIC GIVEN seek advice if
        
        Symptoms (such as sputum colour changes and increases in volume or thickness) worsen rapidly or significantly or
        
        Symptoms do not start to improve within an agreed time
        
        systemically very unwell.
      - Consider viral causes if sputum white/not purulent