Skip to main content


Showing posts with the label Emergency medicine

COPD exacerbation - definition, assessment, management

COPD exacerbation: Definition: Exacerbation of COPD is defined as an acute episode, characterized by the worsening of the patient’s respiratory symptoms that is beyond normal daily variations and that will eventually lead to a change in his medications. Those having 2 or more exacerbations per year are known as “frequent exacerbators”. Precipitating factors: 1) Respiratory tract infections – viral or bacterial. Most common cause. There may be an increased bacterial burden in the lower airways or new strains of bacteria are acquired during an exacerbation. Commonly implicated viruses include rhinovirus, respiratory syncytial virus, coronavirus and influenza virus. 2) Air pollution. 3) Interruption of maintenance therapy. 4) Unknown causes – 30% cases. Diagnosis: Diagnosis should be made clinically whereby the patient complains of an acute aggravation of his symptoms out of proportion to his day to day variations.  Assessment: Medical history: 1) Se

Determining the size of the endotracheal tube

Adults:   We must select the largest diameter ETT that can be tolerated  for adults.  A size 7.5-mm cuffed ETT is well tolerated by  most adult female patients.  A size 8.0-mm cuffed ETT is well  tolerated by most adult male patients. Pediatrics:   An uncuffed ETT should be used for children  under the age of 8 years.    The  formula most commonly used is: ETT size(mm) = (Age[yr] +16)/4 To estimate the depth of insertion for a child older than  2 years: Depth of insertion = 3× internal diameter of the ETT