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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Monday, August 16, 2021

emDocs - August 16, 2021 - By Timothy Wong and Linda Katirji
Reviewed by: Alex Koyfman; Brit Long; Summer Chavez
Main Points:
  1. 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.
  2. 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.
  3. 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.
  4. 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.