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Thoracic Medicine
Chronic obstructive
pulmonary disease
Edited by Chien-Da Huang
Physician Educator/Associate Professor
Department of Thoracic Medicine and Medical
Education
Chang Gung Memorial Hospital
Taipei, Taiwan
-- COPD
Peripheral vasoconstriction
COPD
:
What are your main diagnoses of this
patient? And, what is the process of
causal reasoning?
What are your further diagnostic
and/or treatment and health education
plans?
Laboratory findings
Laboratory findings
Leukocytosis with shift to left (WBC: 16,000
Seg:85%, Band: 5%)
BUN: 20 mg/dl, Cr: 0.8 mg/dL, GOT: 26 U/L, GPT: 32
U/L, Na:142 meq/L, K:2.9 meq/L
ABG: pH: 7.438, PaCO2: 52.9 mmHg, PaO2: 60.0
mmHg, HCO3: 35 mm/L, Sat:90.7%, Room air
Questions to be discussed?
What are the definitions of SIRS/sepsis/septic
shock?
Sputum culture
Neutrophil 3+
Pseudomonas
aeruoginosa
Questions to be discussed?
How and what do you read from the CXR?
2007 GOLD
Guideline:
Stage IV:
Very severe
COPD
2012 GOLD
Questions to be discussed?
What do you know about newest version of GOLD
guideline?
COPD
:
The final diagnosis is COPD with acute exacerbation,
and the severity stage was IV, Category D
COPD
:
How to handle the agitated situation?
How to let the patient to agree your
treatment plan?
Individualized Treatment for this
Patient
Medicine
Tiotropium + Fluticasone/salmeterol (high
dose)
Hospital-Based Pulmonary Rehabilitation
Program
Mucus clearance technique
Exercise training program
Walking
Upper limbs training
Inspiratory muscle training
Transcutaneous Electrical Stimulation (TENS)
Oxygen supplement
Vaccination
MCQ Question 1
The patient complained of aggravated dyspnea during
the recovery phase of acute exacerbation in
outpatient clinic.