A 68-year-old with wheezing


Chronic Obstructive Pulmonary Disease (COPD)

by Ramin Tabatabai, David Hoffman, and Tiffany Abramson, USA

A 68-year-old male presents to the emergency department (ED) with audible wheezing, and he is in severe respiratory distress. He is speaking in 2-3 word sentences, and he is diaphoretic and slightly confused. Per the paramedic report, the patient is a two pack per day smoker. On physical examination, the patient demonstrates poor air movement, and you note that he has a “barrel chest.” As you pick up the phone to call the respiratory therapist for airway management, you wonder, “What other interventions should I initiate and are there other diagnoses I should be considering?”

What is the value of BiPAP on COPD?

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The use of BiPAP led to decreased mortality (NNT=10), reduction in treatment failure (NNT=5) and decreased need for intubation (NNT=4).

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