Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive dyspnea on exertion, chronic productive cough, and increasing peripheral edema. History significant for long-standing COPD. Symptoms include orthopnea, fatigue, and occasional syncope. No chest pain reported. Current oxygen requirements noted.
Clinical Examination Findings
Vitals: Tachycardia, tachypnea, hypoxemia. Cardiovascular: Elevated JVP, palpable right ventricular heave, loud P2 component of S2, holosystolic murmur at the left sternal border (tricuspid regurgitation). Pulmonary: Barrel chest, distant breath sounds, wheezing/crackles. Extremities: Bilateral pitting edema, cyanosis.
Treatment Protocol
Optimize COPD management: Long-acting bronchodilators, inhaled corticosteroids, and supplemental O2 to maintain SpO2 >90%. Diuretic therapy (e.g., Furosemide) for volume overload. Consider pulmonary rehabilitation and smoking cessation counseling. Monitor electrolytes and renal function.