You are given the history of the patient, that they are a long-term sufferer of COPD and have flare ups every so often. Today, the patient was rushing to get things done as he had an appointment with the GP in the afternoon. He has become breathless and came to stop on the kitchen chair. The carer arrived and was concerned for the patient due to his breathlessness. They called 999.

You start reviewing the patient and work through their observations. You note O2 saturations of 92%. Can this be a normal range for a COPD patient

What oxygen saturation should you aim for if you were going to administer oxygen to a COPD patient

You continue through your survey and note a slight wheeze and some bilateral basal crackles on auscultation. On questioning the patient further, he explains his COPD has been worsening these past few days. You feel the patient currently has some exacerbation to his COPD and would benefit from some medication. What nebulised drug would you consider as a first line treatment

What further nebulised medication could be given if the Salbutamol failed to alleviate the symptoms

You administer the Salbutamol nebuliser to the patient. When nebulising a COPD patient, is there a time limit on how long you should nebulise

If you had to give further repeat Salbutamol nebulisers to treat the COPD symptoms where there may be life threatening symptoms, what is the total maximum dose you can give

Following 6 minutes of a Salbutamol nebuliser, the patients’ breathing has eased and his symptoms have calmed. He advises you that the ‘ambulance’ nebulisers always work. You continue your assessment and observations and note no further deficits. Following nebulisation, his observations include: RR 21, SPO2 96% on air, HR93, Temp 37.2, BP 122/81. What is his current NEWS2 score

You discuss the patients’ recent history with his COPD. He discusses it has been worse these past few days, more so when he’s been up and about. He’s been using his own nebuliser more often to help with the breathlessness and has considered giving the GP a ring to discuss. Otherwise, he has been managing fine at home, and the care he receives 3 times a day for preparation of his food and general house cleaning helps him overall in staying independent in his home. Under the NICE guidelines, what severity of exacerbation level would the patient be under up to the point of 999 being called

The patient has good conversation with you while you complete some further observations and paperwork. You consider what is the best course of treatment and care for the patient. True or False, some COPD patients have ‘rescue/COPD’ packs at home for COPD exacerbations

You discuss if they have a treatment pack for their COPD and he recalls a pack he keeps in one of the kitchens draws. You have a quick look and see it is a COPD pack for exacerbations with all antibiotic and steroid medication in place. You discuss that you feel the patient will benefit more from staying at home and utilising their COPD pack following the correct referrals and phone calls. The patient agrees with this, so you call a clinical desk paramedic and discuss the case with them. Following the conversation and review, the paramedic agrees and makes a call to the patients’ GP to discuss the COPD pack use and arranges follow up care and support. As you finish the paperwork, the paramedic calls and confirms that the GP is aware and is happy for the pack to be started. A respiratory nurse will be out in the afternoon to discuss further with the patient. You leave the property and the patient thanks you for your care.

When dealing with any COPD patients and leaving them at home, you should always