- Patient: Breathless.
- Usual Presentation: Shortness of breath
- You
– Acknowledge + can you tell me what happened?
– Take short history.
– SOBE- Analysis ? Had it before? Chest Pain? Heart Racing ? smoker’s cough? Medications ? Medical Conditions ? Allergies?
Monitor Either
- I would like should attach the monitor
- I can See my patient is attached to the monitor.
Interfere ( ABCDE )
A- Airway. ( Since he is talking Airway is patent )
- Check SPO2- 84%
- Propped up position
- Venturi mask O2 in room air 28-40 % (2-10L/min) Maintain SPO2- 88-92%
B- Breathing.
- Examine chest- Auscultation? Wheeze?
- Take Chest X-ray + ECG + ABG.
**Salbutamol + Ipratropium bromide- Repeat
Note:
- Co-existence with Asthma? Infection? Severe symptoms? Then start with Salbutamol + Ipratropium bromide
- If Mild symptoms then SABA +/- LABA +/- ICS
C- Circulation.
- Check : Capillary Refill + Pulse + BP + Insert 1 Cannula.
- Take Blood ( routine blood invx ).
- Oral **prednisone 30mg
– IV Steroids/ Hydrocortisone 100mg/ Methypred
– Antibiotics should be given to patients with an increase in purulent sputum, consolidation on CXR or clinical signs of pneumonia
D- Disability.
- Check : Blood Sugar + Temperature.
- Re-assess.
E- Exposure.
- Check Abdomen : ( Quickly ).
- Re-assess.
Other investigation:
- Full blood count: This may identify anaemia as a cause of breathlessness
- Urea and electrolytes
- Theophylline level if the patient is already on theophylline therapy
- Sputum analysis: if sputum is purulent a sample should be sent for microscopy, culture and sensitivity
- Blood cultures if pyrexia present
Follow up in 2 weeks e CXR
Safety net
SUMMARY:
- Venturi mask ( 88-92 )
- Nebuliser (should be deliver by AIR)\
- Salbutamol
- Salbutamol & ipratropium
- All patient with COPD Ex should start course of prednisolone 30mg (7-14 days)
- Antibiotics (ONLY IF SIGNS OF INFECTION)