COPD Exacerbation - CRASH! Medical Review Series

[@pwbmd]

This video has been updated and condensed: kzbin.info/www/bejne/iHrXhYhqq62fhdU

[@andrewpaliobeis6777]

Hi Paul, I'm a med student and your lectures are extremely helpful for reviewing. Just wanted to thank you for taking the time to make these videos. Cheers!

[@nancyhahn4182]

Excellent presentation for those of us with this ugly disease. Thank you!

[@dr.greggsuzanneferguson5767]

Dr. Bolin, Thank you for your insight and devotion to care. I have a question: my mother who suffered from COPD was having shortness of breath. We called the ambulance for transport to the hospital, and begged them not to have her lay back on the gurney because the pressure on her lungs was causing her severe pain, panic, discomfort. They INSISTED that she had to lay back and she tried to calm down and measure her breathing in order to get to the hospital 20 minutes away. Trailing the ambulance, we watched through the door window as she struggled to pull herself upright to catch her breath, then she laid back and we hoped she'd found a way to calm herself. We parked the car as they raced her in the hospital ER. She was pronounced deceased 15 minutes later, never regaining consciousness from her struggle. We were devastated, despondent and deep down knew her transport position was a factor. Is there ANY protocol for transporting patients with COPD the paramedics should have known and provided? Thank you.

[@oraahsameadanhassan2363]

Am sorry,,,RIP mum but paramedics sh'd allow the position at which the patient finds the best to get his/her breath

[@Sam_1964]

This is excellent presentation

[@alanfennell4833]

My mother died from copd in 2017, I really wish I had tried harder to get her to quit smoking as a kid. If you are reading this and have a loved one who smokes please do everything you can help them quit as soon as possible. It's not easy, but it's easier than dying from copd, I imagine. Miss you mom hope you are able to catch your breath up there.

[@alanfennell4833]

Don't know why I watch these videos guess it reminds me of her in some strange way

[@notnownotever1659]

I have severe copd, recently spent 2 days in the hospital, My ox level was in the 90 to 92 level. once at home bought a good quality oximeter and now average 88 to 93 readings. I went to see my primary care Dr. a few days ago for general check up. The gal who took my vitals stuck the oximeter on my left index finger and after a couple seconds it popped up a 96, she grabbed it right off and wrote down that number. My meter always either initiates with a high number or a low # then proceeds to settle on the actual # in my case which is about 90. I test my wife and step son to see if it shows a normal reading and it always does, so I believe the meter is accurate. Luckily I have an appt. w/my pulmanary Dr. in 2 days. I currently experience frequent unproductive hard coughing episodes that go to the very brink of complete black outs.

[@Sam_1964]

I hope you feel well. It is very important to leave the Pulse ox for 15 seconds to get accurate reading. You need to talk to your Pulmonologist to address Cough syncope with smoking cessation/Use of LAMA and low dose Gabapentin)

[@sgillman16]

I'm 28 and have COPD with frequent exacerbations. I do forget to use my symbicort, but I still think I'm getting them too much

[@matheusccunha]

Are you diagnosed with alpha-1-antitripsin deficiency?

[@sgillman16]

@@matheusccunha no. I had it checked twice by 2 pulmonologists

[@BakerBoy-to4yk]

@@sgillman16 What is their explanation for your case?

[@jamescorless8283]

I have copd, high stress can set me off.

[@samryon3615]

Me too. I do not like Ativan bit since my last exacerbation i was told i need to take them so i dont mess around anymore. Too scary

[@wakeup6910]

Got that right

[@gidget9101]

Me too

[@whityreddydr1775]

Need more explanation on fev1,fvc in copd

[@tarek6359]

why can't we use morphine/Codeine? Because if they have high RR and have dyspnea, with the help of opioids we can help them take more deeper breaths and reduce their RR and alleviate their dyspnea. What do you think about this?

[@md.metindarici]

No!

[@tarek6359]

But they do this in palliative care. They give morphine for dyspnea

[@md.metindarici]

his or her main problem is not fast-shallow inspiration as in panic attack. we basically give bronchodilators and steroid to open airways and reduce inflammation ,compliment it with some O2 then most of em get over the exacerbation.some may need non-invasive or invasive ventilation and antibiotherapy .u may refer to pathophysiology here nurseslabs.com/wp-content/uploads/2016/09/COPD-pathophys1.png@@tarek6359

[@alanfennell4833]

Correct me if I am mistaken but don't opioid pain killers depress your breathing? Or am I missing something? Not trying to argue with you just curious about it.

[@jess1910]

hi Paul! I've got questions if you don't mind. 1) I've heard of hypoxic drive in COPD exacerbations whereby 02 levels should Not be very high. So what is the cut off point for the 02 saturation level? 2) B agonist - high dose. Do we give them long acting B Agonist? ----> for both outpatient and inpatient management?

[@eelivia]

For your second question, you'll get the idea of which to use if you watch his video on asthma. You want to give LA when the patient is relatively stable. During exacerbation, you'll want to give a SA one because it acts fast.

[@jess1910]

+Livvy Liv thank you so much:)

[@juliaconroy7592]

Jess K l

[@Sam_1964]

The goal is to keep O2sat 88-92 %

[@mawaddasulieman5433]

Thanks Please more

[@cheezyme2984]

What’s PO corticosteroids ?

[@taylahcullen26]

orally taken corticosteroids

[@gordonwaite2]

Prednisone usually 40 mg once a day for 5 days!

[@lydiacartagena643]

I was just in the emergency for this copd flair up

[@sgillman16]

Lydia Cartagena I typically just go to urgent care. Cheaper and faster

[@samryon3615]

@@sgillman16 i was having exacerbations for over 18 months before an ER doc told me what was happening. All my other docs(i am on hospice/palliative) had me wear heart monitor and do a bunch of tests. Finally this last time i went to ER, i had 4 'episodes'(where i cant inhale) and they told me. Is there anything that ER can do that urgent care cant? I go to ER because i feel like i am going to die when i camt breathe in.

[@jamesclaydon4803]

That's a terrible feeling that most do not understand! Worse than a fish out of water! Sometimes feel that dying would be the only relief!!@@samryon3615

[@miriami7]

thank you

[@surra164]

thnx so usful

[@lisaseaton9482]

Don’t agree with you saying chronic smokers I wasn’t and I’ve got it your genes can play a big part in it