COPD Patient Hot Case
GENERAL APPROACH
- Stable of illness – acute, respiratory weaning
- Ventilation strategy – NIV, invasive, weaning strategy
- Tracheostomy consideration
- Nutritional state
- Quality of life and prognosis
- Brain
- Cough
- Nerves
- NMJ
- Respiratory Muscles
- Pleura
- Airways (large and small)
- Parenchymal
- Chest wall
- Ventilator asynchrony
- Cardiac failure
- Abdominal distension/failure
INTRODUCTION
CUBICLE
- long stay
- isolation (MDRO)
- sputum
INFUSIONS
– antibiotics (MDRO)
– noradrenaline (sepsis)
– sedation (dexmetetomidine)
– bronchodilators
– steroids
– feeding
VENTILATOR
- type of support (NIV, IPPV)
- mode
- level of support
- level of oxygenation (FiO2, PEEP)
- disease specific questions (dynamic hyperinflation, intrinsic PEEP)
- rapid shallow breathing index (RR/TV)
MONITOR
- temperature
- tachycardia (SIRS)
- ETCO2 (COPD curve on trace indicating differing type alveolar time constants)
- CVP (number, waveform)
- arterial trace (pressure, swing, pulsus paradoxus)
EQUIPMENT
- ICC (pneumothorax)
- surgical scars
- tracheostomy (size, type)
- intra-abdominal drains (fluid, amount)
QUESTION SPECIFIC EXAMINATION
- hands/arms -> head -> chest -> abdo -> legs/feet -> back
-> cardiovascular (cardiac failure)
-> respiratory (tracheostomy, cough, VC, work of breathing, active disease signs)
-> abdominal (distension)
- neurological
-> paralysed
-> quick examination
-> unconscious
-> conscious (analgesia adequate)
- physiotherapy frequency
RELEVANT INVESTIGATIONS
- CXR
- FBC: WCC
- microbiology: sputum, blood cultures
- ABG: gas exchange
- pre-admission spirometry
OPENING STATEMENT
=
- severity and stage of disease
- factors contributing to respiratory failure or weaning
- management from here
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC