Adult Medical Emergency Handbook - Scottish Intensive Care Society

other factors. Consult local antibiotic guidelines or microbiologist
for advice.
ACUTE EXACERBATIONS OF COPD
Chronic obstructive pulmonary disease (COPD) is the preferred term.
Acute exacerbations of COPD present as a worsening of the previous
stable situation.
Symptoms
• Increased breathlessness.
• New or increased sputum purulence.
• Increased sputum volume.
• Increased wheeze.
• Chest tightness.
• New or increased ankle oedema.
Important features in the history
• Previous exercise tolerance.
• Social circumstances and quality of life, especially whether living
alone/alone with support/with family; whether housebound.
• Current treatments, including home nebulisers and oxygen
therapy.
• Number of previous admissions in past five years.
• Number of admissions to ICU.
• Previously ventilated?
• Time course of current exacerbation.
• Smoking history.
IMPORTANT SIGNS
• Frankly purulent sputum
• Tachypnoea, wheeze and use of accessory muscles with
increased work of breathing.
• Pyrexia
• Cyanosis
• Confusion
• Peripheral oedema
Initial Investigations
Priority
152 adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11