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COPD exacerbation - admit

This patient presents with symptoms most consistent with an acute COPD exacerbation. These constellation of symptoms are similar to prior flares without overt deviations from normal exacerbations. The likely precipitant is acute respiratory infection // weather change or air quality // recent beta-blocker or opiate use. Low suspicion for alternate etiologies such as pneumothorax, acute PE. Presentation not consistent with other acute cardiopulmonary causes including ACS / CHF / cardiac effusion.

Pseudomonas risk factors: recent hospitalization // frequent antibiotic treatment // severe COPD // previously isolated Pseudomonas. Plan to maintain SaO2 ~90-94% with supplemental O2. Based on current presentation, including work of breathing, patient will need NIPPV (CPAP/BiPAP) // will not need NIPPV at this time. Plan for trial of duonebs, steroids. Antibiotics  indicated given purulent sputum // increased sputum production // trial of NIPPV // No indication for antibiotic treatment at this time. Will evaluate for other acute cardiopulmonary processes with a CXR.

Anticipate hospitalization given marked increase in symptoms // significant co-morbidities and age // new arrhythmias.

Plan: supplemental O2 (goal SaO2 ~90-94%), NIPPV , duonebs, steroids, antibiotics , CXR , serial reassessment

from natedotphrase.com

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