QuestionSBA
QuestionChoice
This is important to identify the causative organism so the most effective antibiotic can be given.
10005748
c
Take blood cultures
QuestionChoice
The aim is to keep saturations above 94%.

However, people with moderate to severe COPD naturally have a degree of hypercapnia and are unable to respond to this as a respiratory driver. They therefore relay on hypoxia as a respiratory driver. In these cases saturations should be maintained between 88-92% to maintain a respiratory drive.

Oxygen is important to avoid organ damage due to hypoxia.
10005747
b
Administer oxygen
QuestionChoice
Infective exacerbation of COPD is suspected due to the previous diagnosis of COPD and features of infection such as pyrexia and green sputum. Sepsis can be diagnosed as there is a suspected infection + more than 2 out of the 4 criteria for systemic inflammatory response syndrome (SIRS): fever, tachycardia and tachypnoea. The other being white blood cell count which is unknown.

CRP can be performed as part of the work up to determine the degree of inflammation in the body and to monitor the response to treatment overtime but is not essential within the first hour of diagnosis.
10005746
a
Take blood CRP
QuestionChoice
Lactate can be a marker of tissue hypoperfusion. The more raised the worse the prognosis.

A level over 4mmol indicates severe sepsis with a poorer prognosis.
10005750
e
Take blood Lactate
QuestionChoice
Sepsis patients usually have a low blood pressure. IV fluids are important to increase the blood pressure to allow blood supply to vital organs.
10005749
d
Administer IV fluids
Concept
Chapter
2693
4035
Sepsis
Topic
161
Emergency Medicine
13696
A 75 year old male with a past medical history of COPD presents to the emergency department with worsening breathlessness, wheezing and a productive cough with green sputum.

His vital signs are taken:

>Respiratory rate: 22 breaths per minute
>
>Oxygen Saturations 87% on air
>
>Blood pressure 95/60mmHg
>
>Heart rate 110 beats per minute
>
>Temperature 38.7ºC
>
>Alert

Infective exacerbation of COPD and Sepsis is suspected.

Which of the following is least appropriate in the initial management?
a