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COPD Exacerbation


This accelerated treatment protocol requires frequent reassessment



Transfer Criteria

  • Good response to initial therapy (β-agonists, iaprotropium, steroids).
  • No acute process on chest Xray (required)
  • Acceptable VS (PO2>90, HR<100, RR<24, SBP>100)
  • Alert and oriented
  • No indication of impending respiratory fatigue

Exclusion Criteria

  • Acute co-morbidities - Pneumonia, CHF, cardiac ischemia
  • Unstable VS or clinical condition
  • Acute confusion / lethargy, elevated pCO2 (if drawn) or evidence of CO2 narcosis
  • Poor response to initial therapy
  • O2 sat < 85 on 2 L O2 after 5 mg aerosolized Albuterol
  • Persistent use of accessory muscles, RR>28 after initial treatment
  • Estimated likelihood of discharge from observation unit is less than 70%

Potential Interventions

  • Serial treatments: β-agonists Q2-4hr, iaprotropium Q6hr, and steroids
  • Hydration, antibiotics if indicated
  • Pulse oximetry (continuous or q4hr), ABG if indicated
  • Supplemental oxygen as indicated
  • Reassessment Q4 hours
  • Cardiac monitoring, cardiac markers, ECGs, and BNP - as needed

Discharge Criteria

Home

    • Resolution of exacerbation or return to baseline status
    • Pulse-ox > 90% on room air or home FIO2, back to patient’s baseline

Admit

    • Progressive deterioration in status, Unstable VS
    • Failure to resolve exacerbation within 18 hours
    • Co-existent pneumonia or CHF
    • Uncompensated pCO2 Retention
    • O2 sat < 90 % on room air or home FIO2



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