Management of acute exacerbation of chronic obstructive pulmonary disease

Oxygen should be given for exacerbation of chronic obstructive pulmonary disease, aiming for oxygen saturation values of 90-92% with corresponding partial pressures of arterial oxygen of 60-65 mmHg. These targets ensure acceptable haemoglobin saturation whilst reducing the liklihood of the hypercapnia that can accompany the use of supplemental oxygen.

Bronchodilators increase the FEV1 and forced vital capacity (FVC) by 15 to 29% over 60 to 120 minutes.

Beta adrenergic agonists are often used as first-line treatment for acute exacerbations of chronic obstructive pulmonary disease, but have not been shown to be superior to anticholinergic agents and the two classes of agent are often used in combination. Side effects are less frequent and milder with ipratropium bromide than with beta agonists.

Metered dose inhalers are cheaper than nebulisers.

Reference

• Stoller JK. Acute exacerbation of chronic obstructive pulmonary disease. N Engl J Med 2002;346(no13):988-994.

Epinephrine for anaphylaxis

In anaphylaxis, a treatment with intramuscular epinephrine (0.5 ml of 1/1000) is required.

In extremis, epinephrine can be given intravenously, but at reduced dosage: make a 1/10,000 solution (by diluting 1 ml of 1/1000 to 10 ml with 0.9% saline) and give this at 1 ml/min (0.1 mg/min) until a response has been obtained (or a total of 0.5 mg - 5 ml - has been given).