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Chronic Obstructive Pulmonary Disease, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • 3rd leading cause of death in US

  • A disease characterized by airflow obstruction due to several processes:

    • Emphysema: Irreversible alveolar destruction with loss of airway elastic recoi...

Diagnosis

Signs and Symptoms

History

  • Dyspnea on exertion

  • Cough

  • Sputum production

  • Fatigue

  • Wheezing

  • Orthopnea

  • Altered mental status

Physical Exam

  • Wheezing

  • Retractions

  • Decreased air movement

  • Cyanosis

  • Prolonged expirat...

Treatment

Pre-Hospital

Supplemental oxygenation: 
  • 100% via nonrebreather

  • Do not withhold for fear of CO2 retention.

  • Initiate nebulized bronchodilator therapy.

Initial Stabilization/Therapy

  • Oxygen therapy:

    • Ma...

Follow-Up

Disposition

Admission Criteria

  • ICU admission:

    • Intubated patients

    • CO2 narcosis with oxygen saturation <90%

    • Clinical tiring in the ED

    • Severe acidosis

    • Concomitant cardiac or pulmonary disease

    • Acute ...

Pearls and Pitfalls

  • Noninvasive positive pressure ventilation is the therapy of choice when optimal medical therapy is insufficient

  • Nebulized steroids may be used more for acute exacerbation of COPD in...

Additional Reading

  • Agusti  A, Barnes  PJ. Update in chronic obstructive pulmonary disease 2011. Am J Respir Crit Care Med.  2012;185:1171–1176.

  • Celli  BR. Update on management of COPD. Chest. ...

Codes

ICD9

  • 491.9 Unspecified chronic bronchitis

  • 492.8 Other emphysema

  • 496 Chronic airway obstruction, not elsewhere classified

  • 493.20 Chronic obstructive asthma, unspecified

  • 491.21 Obstructive chronic bron...

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