If a COPD Pt w/ Acute SOB, productive Cough, Confused, Diaphoretic, PaO2 55 & CXR shows Complete Lung Consolidation. Has TakingAlbuterol, Propoterenol & Budesomide w/o Relief of Breathing Difficulties
What do you suspect and what would you recommend as the next step?
Any pt. with copd with acute sob, first thing to come to mind is infection, 60% of them will have viral infection but however, we need to cover them up with antibiotics.
Give o2, iv steroids along with bronchodilators.... note: we give steroids in copd only during acute excerberation.
That's great, and now lets say u did all that and Sx;s did not resolve, what would be ur next step? What are you suspecting now?
suspecting mucus plugging - do bronchoscopy
Despite sufficient broncho dilation and oxygenation---- pt didn't improve---------meaning oxygen is not reaching lungs as said by isabelle suspect a mucus plug---- has a h/o productive cough, do bronchoscopy to get rid of it....
What do u say ben?
Pt w/ complete Right or Left Collapse, as seen on CXR as Opacification which could be d/t Mucus Plugging & causing Obstruction.
If Pt isExhibiting Severe Features of Resp. Distress such as Confusion & Diaphoresis, and all the standard Mx did not resolve his Sx's then Pt need Urgent Bronchoscopy to Remove a Posiible Mucus Plug.
Removal is associated w/ Rapid Improvement of PaO2 & a Quick Symptomatic Relief