Chronic obstructive pulmonary disease
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ED Discussion: 80mg prednisone as soon as they come in. Then nebs and nonrebreather. Get IV, cxr. Give O2 to a goal O2 sat of 91-92%. After a while 125 solumedrol. get labs and make sure you are not missing CHF or MI (get Ekg/card enzymes, CXR). Get ABG and see if Co2 retainer or not. If they are, give just enough O2 to 02 sat 90-91%. If they start crashing, bolus again with 125 solumedrol (there is no max to solumedrol, in mult. sclerosis exacerbation they sometimes get 800 mg !!!) if still crashing, Bipap 10/5 can be a bridge to intubation. Magnesium 2 grams over 30 minute. Heliox. still crashing, intubate. Use less tidal volume d/t concern for bleb rupture.
 Imaging Findings
 Plain film
- Flattening of the diaphragm
- Increased retrosternal air space
- Long narrow cardiac silhouette
- Hyperlucency of the lungs
Patient #1: Smoker with SOB