care, treatment and destination for COPD

how do you care for someone with an acute COPD exacerbation?

• move them to a calm and quiet environment

• consider positioning - have pt sitting up/leaning forward

• consider pts personalised individual treatment plan

• try and reduce anxiety in patients as this can worsen breathing - encourage breathing techniques

• early respiratory assessment is vital

what medication may you give to someone with acute exacerbation of COPD?

• patients own rescue meds?

• salbutamol first

• consider oxygen, target pts o2 sats range

• ipratropium bromide if pt unresponsive to salbutamol

• hydrocortisone

how does salbutamol work?

• salbutamol is a beta2 adrenoreceptor stimulant drug

• works to relax small and medium airways, relaxing the smooth muscle

• administered by nebuliser additionally moistens the airway

• this treats bronchospasm, allowing normal breathing to resume

what are the indications for salbutamol?

• exacerbation if COPD

what are the contraindications for salbutamol?

• none in an emergency setting

• use with care in pts with hypertension, angina, overactive thyroid, late pregnancy (may relax uterus), pts taking beta-blockers

what is the dose for salbutamol?

• aged 6+ - 5mg every 5 mins

• aged under 6 - 2.5mg every 5 mins

• no limit on dose

how does ipratropium bromide work?

• antimuscarinic bronchodialtor (block the actions of acetylcholine, which causes muscle contraction)

• IB considered to be of greater benefit in adults suffering with COPD

what are the indications for ipratropium bromide?

exacerbation of COPD, unresponsive to salbutamol

what are the contraindications for ipratropium bromide?

• none in emergency situation

• use with care in pregnancy and breastfeeding

what is the dosage for ipratropium bromide?

• adults

• 500 micrograms

• 250 micrograms in 1ml, in 2mls of fluid

• max dose 500 micrograms

• 18 months - 11 years

• 250 micrograms

• 250 micrograms in 1 ml

• max dose 250 micrograms

• 12 months and under

• 125-250 micrograms

• 250 micrograms in 0.5-1ml

• max dose 125-250 micrograms

no repeat dose!!

how does hydrocortisone work?

• reduces airway inflammation and swelling by suppressing immune response

what are the indications for hydrocortisone?

acute exacerbation of COPD

what are the contraindications for hydrocortisone?

• known allergy

what is the dosage of hydrocortisone?

• given IV over min of 2 mins, IO or IM

• adult

• 100mg

• 100mg in 1 ml

• max dose 100mg

• 5 years - 12 months

• 50mg

• 50mg in 0.5ml

• max dose 50mg

• 9 months - 1 month

• 25mg

• 25mg in 0.25ml

• max dose 25mg

• birth

• 10mg

• 10mg in 0.10ml

• max dose 10mg

no repeat dose!!

considerations for administering O2 in COPD pts?

• if COPD pt requires oxygen, do not withhold

• in short-term while pt is with ambulance, hypoxia presents greater risk than hypercapnia

• monitor pulse ox + aim for 88-92% or the patients specialised range

• COPD pts may be chronically hypoxic and supplementary o2 may reduce respiratory drive

• if happens, reduce o2 and assist in ventilation if needed

• consider 6mins on, 6mins off

when can you consider discharging a COPD pt at home?

• pt able to cope at home

• mild breathlessness

• good general condition

• good level of activity

• no cyanosis

• normal level of consciousness

• good social circumstances

• not receiving long term o2 therapy

• no rapid onset

• SATS above 90%

• no significant comorbidity

when should you transport a COPD pt to hospital?

• pt not coping + poor social circumstances

• severe breathlessness

• poor/deteriorating condition

• poor level of activity

• centrally cyanosed

• recieving long term o2 therapy

• impaired level of consciousness

• significant comorbidity

• rapid onset symptoms

• SATS less than 90%

where should COPD pt be taken?

• nearest ED