Respiratory
COPD exacerbation and oxygen
Treat an exacerbation, and do not chase a normal saturation with unrestricted oxygen.
Educational only. A local note appears only when a public source is attached. This page does not say that one exam, or training in one country, makes you eligible to practice in another.
Global core
COPD is persistent airflow limitation, usually after tobacco or another exposure. An exacerbation is a sustained worsening of breathlessness, cough, or sputum. Bronchodilators treat the attack. A systemic steroid is often used. Some patients retain carbon dioxide if oxygen is given without a target. The saturation target, the antibiotic, and the rules for long-term oxygen are local and are not given here as one number.
What stays the same
- A sustained worsening of breathlessness, cough, or sputum is an exacerbation.
- Some patients retain carbon dioxide when oxygen is uncontrolled.
- Bronchodilators treat the attack. The antibiotic and the home-oxygen rule are local.
- Recognize. A person with COPD who is more breathless, or whose sputum has changed, over hours to days.
- Reason. Look for hypoxia, drowsiness, and a rising carbon dioxide. Ask what oxygen was already given.
- Prioritize. A silent, drowsy patient is ventilatory failure, not comfort.
- Act safely. Controlled oxygen toward the target prescribed for that patient, a bronchodilator, and senior help if he is tiring. Do not chase a normal saturation by habit.
Local adaptation
No sourced local note is attached to this topic. That is not a statement that every country manages it the same way. The shared principle above is what this beta is willing to teach.
Exam lens
The next change in a drowsy patient who was given high-flow oxygen.
Original case · shared decision
The lens above is how that exam usually frames the medicine. This case stays on the shared decision. Not an official examination item.
A 74-year-old man with severe COPD arrives drowsy after high-flow oxygen in the ambulance. Saturation is 99% on that oxygen. An arterial gas shows a high carbon dioxide and a respiratory acidosis. He is still protecting his airway. What is the most appropriate immediate change?