[##]-year-old [male/female] with history and exam consistent with acute exacerbation of COPD.
Initial consideration in this patient included exacerbation of COPD, acute decompensated heart failure, acute coronary syndrome (ACS), acute bronchitis, pneumonia, influenza, asthma exacerbation, allergic rhinitis, upper respiratory infections (URI), foreign body airway obstruction, pulmonary embolism (PE) among others.
Patient presented for [cough/shortness of breath/wheezing] with a known history of COPD consistent with acute exacerbation. Patient’s lung sounds were [notable for expiratory wheezing/noted to be normal]. Patient noted to [have/have no] evidence of fever [or other systemic infectious symptoms]. A chest x-ray was obtained [and noted to have no evidence of consolidations suggestive of pneumonia or other acute abnormality/specify findings]. An EKG was obtained and [noted to have no evidence of acute abnormalities/notable for atrial fibrillation without rapid ventricular rate/multifocal atrial tachycardia/notable for chronic findings consistent with COPD].
Treatment was initiated with nebulized bronchodilators (albuterol and ipratropium) and [oral/intravenous] corticosteroids. Patient was noted to have [significant improvement with this treatment/persistent symptoms which prompted further treatment with intravenous magnesium sulfate. The patient was ultimately noted to have significant respiratory distress requiring initiation of non-invasive positive pressure ventilation (NIPPV).] [The patient was noted to have a measured peak expiratory flow rate (PEFR) of [##]% predicted after treatment in the ED consistent with mild/moderate/severe/very severe COPD.]
Acute decompensated heart failure was felt to be a less likely cause of the patient’s symptoms given [absence of evidence of significant pulmonary congestion, peripheral edema, or other findings suggestive of volume overload and an unremarkable brain natriuretic peptide (BNP)]. Patient noted to be high risk for failure of outpatient management based on [Ottawa COPD Score as noted above/failure to significantly improve with treatment in the ED]. Antibiotics were felt to be indicated in the setting of [moderate/severe] exacerbation requiring admission.
Acute decompensated heart failure was felt to be a less likely cause of the patient’s symptoms given [absence of evidence of significant pulmonary congestion, peripheral edema, or other findings suggestive of volume overload and an unremarkable brain natriuretic peptide (BNP)]. Patient noted to be high risk for failure of outpatient management based on [Ottawa COPD Score as noted above/failure to significantly improve with treatment in the ED]. Antibiotics were felt to be indicated in the setting of [moderate/severe] exacerbation requiring admission.
The patient [reported/denied] current tobacco use [and we discussed smoking cessation prior to discharge with the patient noted to be pre-contemplative/contemplative/expressing desire to quit at this time].
We discussed planned admission with the patient who demonstrates understanding and agreement with this plan. We discussed case with Dr. [NAME] who evaluated the patient and agrees with need for admission to [general floor/telemetry unit/step-down unit/ICU].
https://www.mdcalc.com/ottawa-copd-risk-scale#evidence
https://rebelem.com/rebel-core-cast-3-0-asthma-copd-pna/
https://www.mdcalc.com/global-initiative-obstructive-lung-disease-gold-criteria-copd
https://litfl.com/ecg-in-chronic-obstructive-pulmonary-disease/
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