emDocs - August 16, 2021 - By Timothy Wong and Linda Katirji
Reviewed by: Alex Koyfman; Brit Long; Summer Chavez
Main Points:
- Patients who have non-improving symptoms despite treatment, persistent abnormal vitals including SpO2 <88% (in COPD) or <93-94% (in asthma), or a new dysrhythmia should be admitted. Those with worsening hypoxia, respiratory acidosis, severe dyspnea requiring assisted ventilation, mental status changes, or hemodynamic instability requiring vasopressors should be admitted to the ICU.
- History of any asthma exacerbation within the last 1 year predicts need for MV in acute asthma exacerbation. GCS<8, acidemia (pH<7.2), and APACHE II score >23 predicts need for MV in AECOPD.
- Patients with concurrent pneumonia or cardiac disease should be considered for admission. Consider a patient’s understanding of their own illness and ability to access medications and follow-up prior to discharge even if he or she improves in the ED.
- Provide counseling on smoking cessation and offer nicotine-replacement therapy to patients in the ED with acute COPD to reduce the risk for future exacerbations and to reduce mortality.