COPD

Foreign.

Okay, so now we're going to talk about copd. Let me start by saying COPD is a very frustrating disease, right? And in medicine, one of the things that we love to do is we want to treat things because we want to feel that we're helping the patient. And COPD is one of those disease that. The reality is you're not really going to help the patient immediately. You're going to prevent what's called the complication. So let's start using the pathophysiology of copd. COPD is a destructive process, right? Asthma is an inflammatory inflammation that can be reversed, right? So copd, it is not reversible. The damage has already been done or is completed, right? So some of those patients will be at either end stage copd. Emphysema, different style, they're unable to get breath air in. That's the main difference with asthma. Asthma, you're able to get air in, not out, right? Copd, they can get air in, no problem getting it out, right? Their lungs is barrel chest, right? They have large lung, large chest. They're tripoding, right? And then you're seeing numbers. You see an O2 sat of 84. Now suddenly you start freaking out, shaking in your boots, right? And you know, rule number one is check your own pulse first. You have a pulse, you're fine, right? That number of the patient means absolutely nothing. You don't know where that patient lives at, right? If that patient lives at 86 every single day on 2 liters of nasal cannula at home and now suddenly went in the backyard, had a cigarette, took his oxygen off, now he's at 84. Does 86 to 84 means a big difference? Absolutely not. We don't know. But for all of us, we know 84 is a bad number, right? Don't treat the number, treat the patients. And I think that's a crucial information and really important to differentiate because of the harm you can do to those patients. You want to do something and you're trying to use your kits in sync, right? For example, using magnesium. Magnesium will not help in those patients, right? It will not do anything. So we need to rethink, look for the causes. What are the causes that cause the patient to go in? Copd, exacerbation. Most of them will be, A, I took my oxygen off for too long. B, is have fever and I have a cough or it's an infectious process. C, I've been having some chest pain, chest pressure, and maybe it's cardiac origin. D, is their diabetes is out of control. It's generally a complication of something else or simply an exacerbation of their copd. So albuterol, you're helping the alveoli reopen by dilating it. Right? The steroid is crucial. Again, remember, steroid is an anti inflammatory. You're going to be able to give it to the patient, but you're not going to see the effect. Right. And then increasing oxygen as needed to a goal of keeping O2 sat above 90, 92%. And always make sure you follow your protocols. Maintaining an O2 saturation above 90% is the key, not 98. We don't want to normalize any number. We just want to get them into a comfort 88, 90. I'm okay with it. Now, CPAP is an option to give to the patient. And again, you know, you got to remember your contraindication for your cpap. If the patient are hypotensive, that negative inspiratory pressure can drop the blood pressure. If they're sub somnolent or sleepy, you know, they need to be awake and following command. If they have vomiting or if they have any facial trauma or any other contraindication according to your protocol.