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Recommended
Responses for the Case Study |
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- Oxygen. Although
a PO2
of 64 mm Hg on room air with a saturation of 90% appears to be satisfactory,
this is achieved by a labored pattern of respiration, with tachpnea
(R = 22/min), and is accompanied by an increased blood pressure (170/112
mm Hg) and a tachycardia (120 beats/min). In addition, he is mildly
anemic. Relieving his hypoxemia, and thereby reducing his WOB and myocardial
work, may prevent the need for ventilatory support.
- Yes. Ipratropium
bromide is the drug of choice in COPD, including an acute exacerbation.
However, a dose of 2 inhalations from the MDI may be insufficient, and
should be titrated to 6-8 actuations, with a reservoir device because
he is tachypneic and may have trouble coordinating breathing and actuation.
A larger dose of ipratropium can be administered if the SVN solution
of 500 mcg is administered.
- A beta2
agonist, such as albuterol, pirbuterol or terbutaline should be administered
by MDI with a reservoir. This should be administered at the same time
as the ipratropium. In addition, this patient may well benefit from
theophylline.
- Theophylline has a weak
bronchodilating effect in the airways which may help reverse his airway
obstruction, and it has been shown to reduce dyspnea.
- Question the patient on
the use of theophylline prior to admission. If he does recall regular
use of the drug, or any prior use, a theophylline blood level should
be checked as soon as possible.
- Optimal results, with
minimal side effects will be obtained with a blood level of 10-12 mcg/ml
in most patients.
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