Adult Medical Emergency Handbook - Scottish Intensive Care Society

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• ABGs (record inspired O 2 concentration).
• CXR (exclude pneumothorax).
Less urgent investigations
• PEF and start PEF chart.
• FBC, U&Es.
• Sputum and blood cultures.
• 12 lead ECG.
INITIAL TREATMENT
• Oxygen: do not give an inspired O 2 of more than 28% via Venturi
mask or 2l/min via nasal prongs until arterial blood gases are known.
• Check ABG within 20 mins of starting O 2 and within 20 mins of
changing inspired O 2 . Aim to achieve a PaO 2 of >6.6 kPa and H +
of 7.5 kPa.
• Oxygen should be prescibed to achieve a target SpO 2 88-92%.
This applies to this particular group of COPD patients and must
not be extrapolated to other acute conditions such as asthma,
pneumonia, LVF, sepsis and so on.
Bronchodilators
• Nebulised salbutamol 2.5mg and ipratropium bromide 500
microgram should be given on arrival and repeated 4-6 hourly.
• Consider using air compressor and 2l nasal O 2 .
• For distressed patients more frequent salbutamol nebulisers may
be given.
• If the patient is not responding to repeated nebulised
bronchodilators the Respiratory Registrar/Consultant should
be contacted. IV aminophylline may be considered by the
Respiratory/Intensive Care Specialist. Controlled IV infusion of
250mg (maximum 5mg/kg) aminophylline over 20 mins only if
patient NOT receiving oral theophyllines). Magnesium chloride has
not been shown to be a benefit in this situation.
• NIV - non-invasive positive pressure ventilation via face mask
- should be considered for decompensated patients with
hypercapnoea and acidosis H + >55nmol/l: discuss with Respiratory
Specialist.
adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11
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