Respiratory/general I

Front 1

selection of patient with COPD for NIV

Back 1

respiratory acidosis after 1 hour of medical therapy

Front 2

when is patient not suitable

Back 2

if pH <7.26 consider ITU

Front 3

initial set up

Back 3

full face mask for 24h
IPAP 10
EPAP 4-5
rapid increments of IPAP 2-5 every 10 minutes until effect achieved

Front 4

blood gases

Back 4

at 1, 4, and 12 hours

and 1 hour after each setting change

Front 5

duration of NIV

Back 5

until acute phase resolved
pH >7.35 is goal
usually 2-3 days

Front 6

stages of COPD (GOLD criteria)

Back 6

I mild FEV1 >80
II moderate 50-80 mild-moderate symptoms
III severe 30-50 limited exertion
IV very severe <30 very limited inADL

Front 7

investigations in suspected COPD

Back 7

PFT
CXR
FBC

Front 8

initial treatment of COPD

Back 8

SABA or SAMA

Front 9

if still breathless, or exacerbations

Back 9

PFT:
if FEV >50: LAMA or LABA
if FEV <50: LABA+ICS or LAMA

Front 10

assess pt for LTOT if

Back 10

FEV1 <30
polycycthaemia, cyanosis, hypoxia (Sat <92%)
RVF (JVD, peripheral oedema)

Front 11

LTOT for patient with

Back 11

hypoxia -> pO2 <7.3 or
7.3 - 8 and PHT, polycythaemia, nocturnal hypoxia

Front 12

what investigation needed to select pt

Back 12

ABG x2 3 weeks apart

Front 13

if hypercapnic/acidotic on LTOT

Back 13

--> refer for long term NIV

Front 14

initial management acute exacerbation of COPD

Back 14

nebulizer
if sputum purulent -> abx
prednisolone 30mg for 7-14 days

Front 15

investigations in acute COPD exacerbation

Back 15

ABG, CXR, ECG, bloods
if sputum purulent -> culture
if pyrexial -> blood culture
if on theophylline -> levels

Front 16

further mgm of COPD exacerbation

Back 16

IV theophylline if nebulizer not successful
if T2 failure consider NIV
if NIV not available, give doxapram
plan for escalation of treatment before NIV commenced

Front 17

how much oxygen can I give?

Back 17

in patient with T1 failure generally safe
start with 24%
monitor pCO2 and pH. Small increase ok, but pH not to fall <7.25 - then ventilation required