James talks to Dr. Paul Hamor about the management of a patient with chronic obstructive pulmonary disease (COPD) on the wards.
Paul Hamor is a Respiratory and Sleep Physician and Basic Physician Training Network Director at Prince of Wales Hospital. He has interests in the formulation of educational programs, presentation skills, delivering best evidence based-practice to the ward, as well as change methodology.
With Dr. Paul Hamor, Director of Prevocational Training and Respiratory Physician at Royal Prince Alfred Hospital, New South Wales.
Chronic obstructive pulmonary disease (COPD) is a common respiratory condition and can present with varying degrees of severity. This podcast will discuss an approach to a patient with COPD, and how to manage exacerbations of COPD.
You are a junior doctor called to review a 64-year-old lady who presented to ED earlier in the day with a fractured neck of femur and is awaiting operation. Her other comorbidities include COPD and type 2 diabetes. The nurses report that on arrival to the ward, she reports difficulty breathing, desaturating to 86% on RA with a respiratory rate of 28, although she is afebrile. She has a chronic cough which she states is unchanged. Her ABG shows a pH of 7.36, PaO2 of 70, PaCO2 of 52, bicarbonate 33. On examination, she has a generalised expiratory wheeze. She is charted for Seretide 250/25 2 puffs twice daily but has no other medications.
A 52-year-old gentleman has been admitted for investigation of malaena and weight loss, on a background of COPD. You have been asked to review this patient for a fever of 38.6C, tachypnoeic and Sp02 90% on 6L HM.
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