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Diagnosing and treating COPD in the prehospital setting

Distinguishing between COPD and comorbidities, and scaling treatment and pharmacology to disease progression


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Few shifts pass where we don’t care for a dyspneic patient with chronic obstructive pulmonary disease. COPD is included in our differential for almost all adult patients with shortness of breath. However, discerning between COPD exacerbation, acute decompensated CHF and pneumonia can be a daunting task without the luxury of x-rays and lab values.

Part 1: COPD prehospital treatment progression

In Part 1 of our COPD series, we’ll discuss the differential diagnosis of wheezing and review some basics of lung auscultation. Dr. Patrick outlines the typical prehospital treatment progression of COPD as the severity increases, with a review of pharmacology and physiology as well.

Part 2: COPD comorbidities and chameleons

In Part 2, Dr. Dickson and Dr. Patrick pick up where they left off on Part 1 and delve further into the complex differential of a dyspneic patient and discuss several of the “chameleons” that can masquerade as COPD.

If you treat every patient with a COPD history as COPD, you’ll be right most of the time, but eventually, you’ll run into disaster when that pneumothorax sneaks up and bites.

Most of our COPD patients are far from straight forward with multiple comorbidities. After completion of this series, you’ll run your next dyspnea call with a clear plan and loads of confidence.

The MCHD Paramedic Podcast was launched in early 2018 in an effort to provide easily consumable core-content EMS education and insights from prehospital care thought leaders. The Clinical Services Department of The Montgomery County Hospital District EMS service developed the podcast as a tool to better engage and disseminate continuing education to our MCHD medics as well as first responders and EMS professionals nationwide.

Dr. Casey Patrick is the assistant medical director for Montgomery County Hospital District EMS and is a practicing emergency physician in multiple community emergency departments across Greater Houston. His EMS educational focus is on innovative paramedic teaching via the MCHD Paramedic Podcast. Dr. Patrick’s prehospital clinical research involves the investigation of paramedic use of bolus dose intravenous nitroglycerin for acute pulmonary edema and the implementation of lung protective ventilation strategies for intubated EMS patients. Casey and his wife, Alyssa, work and live in Conroe, Texas, and Spokane, Washington. Together they have five children: Mia, Ainsley, Brock, Dean and Will.

Dr. Dickson graduated with honors from the University of Texas Health Science Center San Antonio in 2001 and completed emergency medicine training at Indiana University in 2004. He serves as the EMS medical director at Montgomery County Hospital District EMS and an assistant professor of emergency medicine at Baylor College of Medicine in Houston, Texas. His academic interests include systems of care in stroke and other time-sensitive emergencies, neurologic emergencies and education. He is board certified in emergency medicine in both the U.S. and Australasia, and has subspecialty board certification in EMS medicine. He has authored multiple professional articles and presented at regional, national and international conferences on emergency medicine and EMS topics.