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Triage and immediate risks
Immediate stabilization priorities
Airway protection concerns
Inability to speak full sentences
Copious secretions with poor clearance
Breathing failure concerns
SpO2 persistently < 88% despite oxygen
Rising PaCO2 with pH < 7.35
Circulatory failure concerns
Hypotension or shock physiology
New malignant arrhythmia
High risk phenotypes
Altered mental status or somnolence
Silent chest with minimal air movement
Severe accessory muscle use with fatigue
Initial monitoring and targets
Monitoring and targets
Continuous pulse oximetry
SpO2 target 88% to 92%
If chronic hypercapnia unknown, start 88% to 92% and reassess with blood gas
Cardiac monitoring
Bronchodilator associated tachyarrhythmia risk
Concurrent ACS risk in COPD population
Frequent respiratory reassessment
Work of breathing trajectory
Ability to speak and protect airway
Blood pressure trend
Dynamic hyperinflation related hypotension concern
Ventilatory support escalation
Escalation framework
Supplemental oxygen escalation
Nasal cannula then Venturi mask for controlled FiO2
Avoid high FiO2 without reassessment in CO2 retainers
Noninvasive ventilation pathway
If acute hypercapnic respiratory acidosis
If severe dyspnea with respiratory muscle fatigue
Intubation pathway
If NIV contraindication or failure
If inability to protect airway
Immediate resuscitation bay triggers
pH < 7.25 or rapidly worsening gas exchange
Hemodynamic instability
Rising PaCO2 with declining mental status
Key concepts
Core physiologic problems
Airflow limitation with expiratory flow collapse
Air trapping and dynamic hyperinflation
Increased work of breathing and fatigue
Ventilation perfusion mismatch
Hypoxemia common
Hypercapnia common in advanced disease
Common precipitants
Viral respiratory infection
Bacterial infection
Environmental irritants
Medication nonadherence or poor inhaler technique
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.