COPD Exacerbation — Elderly Male

Patient Information

Dispatch: A 75YO male has presented to the FAP at the Perth Royal Show reporting significant difficulty breathing. (Reg Hollingsworth)
Patient: Reg Hollingsworth — 75yr (75kg)
Incident History: Pt states he has been walking around the showgrounds for approximately 2 hours and his breathing has been getting progressively worse. Pt is a known COPD patient and uses home oxygen at night.
Emergency Contact: Maureen Hollingsworth (Wife) — 0412 883 441

Initial Rapid Assessment

Response: Alert
Airway: Patent. Nil airway obstruction. Nil stridor. Able to speak in 3–4 word sentences.
Breathing: Laboured. Audible expiratory wheeze bilaterally. Accessory muscle use present. Tachypnoeic. SpO2 84% on room air. RR 26.
Circulation: Radial pulse rapid and regular. Skin warm, mild peripheral cyanosis of fingertips. Nil active bleeding.
Disability: GCS 15 (E4V5M6). Alert and orientated to time, place and person. Mild anxiety noted.
Exposure: Barrel-chested appearance. No rashes or visible trauma. Ankles mildly oedematous bilaterally.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	84% (RA)	Moderate	26	108	148/88	<2s	15	4 4 ++	37.1	6.4 mmol/L	2
10 mins	91% (O2 NC 2L/min)	Mild	20	98	142/84	<2s	15	4 4 ++	37.1	6.4 mmol/L	1

History Taking

Treatment Response

Diagnosis

This patient is suffering from an acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD), precipitated by physical exertion and likely allergen/irritant exposure at the showgrounds.

Facilitator Triggers — if trainees miss a critical step

! (If oxygen is applied via non-rebreather mask at high flow without titration, SpO2 rises to 97% — patient becomes more drowsy, RR drops to 12, GCS drops to 13. Facilitator prompts: 'The patient is becoming increasingly drowsy. What is your concern?')
! (If oxygen is not applied within 3 minutes of assessment, SpO2 drops to 80% on room air and patient becomes increasingly agitated and cyanosed.)
! (If trainee does not ask about home oxygen or regular medications, facilitator prompts the patient to mention 'I normally use oxygen at night' only if directly asked about usual health.)
! (If trainee targets SpO2 above 94% and applies high-flow oxygen without reassessment, the patient's respiratory drive reduces — prompting discussion of controlled oxygen therapy in COPD.)

Treatment Objectives

1 Ensure scene safety and don appropriate PPE.
2 Perform Primary Survey — confirm patent airway, identify laboured breathing and wheeze, assess circulation and GCS.
3 Position patient sitting upright or in a position of comfort — do NOT lay patient flat.
4 Apply pulse oximetry and obtain initial SpO2 (84% RA).
5 Administer controlled oxygen therapy — commence via nasal cannula at 2 L/min (FiO2 approximately 28%), titrating to target SpO2 of 88–92%. Do NOT use non-rebreather mask without specific clinical justification. Confirm 6 medication rights: right patient, right drug, right dose, right route, right time, right documentation.
6 Obtain IMISTAMBO history including medications, COPD diagnosis, home oxygen use, and prior salbutamol use at scene.
7 Reassess SpO2, RR, and work of breathing after oxygen application — adjust flow rate as needed to maintain 88–92%.
8 Assist patient to administer Salbutamol via MDI and spacer — patient has own MDI (used twice before arrival with minimal relief); administer 4–12 puffs (400–1200 microg) via spacer, reassess response after 20 minutes. Confirm 6 medication rights: right patient, right drug, right dose, right route, right time, right documentation.
9 Record full observations including BP, pulse, RR, GCS, SpO2, BGL, and pain score.
10 Recognise known cardiac comorbidity (mild cardiac failure) — monitor for signs of fluid overload or clinical deterioration.
11 Reassess observations at 10 minutes — confirm improvement in SpO2 to 88–92% range and reduced work of breathing.
12 Arrange urgent ambulance support via CSP — ambulance — advise CSP of findings of time-critical COPD exacerbation with known cardiac comorbidity.
13 Maintain continuous patient monitoring and reassessment during transport preparation.
14 Scenario ends on arrival of ambulance and IMISTAMBO handover.
15 Attention to hand hygiene will be given throughout the scenario.

Clinical references: Chronic Obstructive Pulmonary Disease (COPD) — Acute Exacerbation · Oxygen Delivery · Dyspnoea & Respiratory Distress · Primary Survey · Pulse Oximetry

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