Algorithm B1: Emergency Room and Hospital Ward

Patient presents with acute exacerbation of COPD [A]
Does patient need mechanical ventilation? [B] Box 2 yes to box 3 Ventilate and perform CPR as indicated [C]
Perform clinical and laboratory evaluation. [D] Initiate/modify cardiopulmonary monitoring. Evaluate and treat comorbid conditions [E] Perform clinical and laboratory evaluation. [D]
Initiate drug therapy (Module B2).
Complete evaluation and treatment of comorbid conditions [E]
Implement/modify pharmacotherapy (Module B2) Box 4 to box 5
Implement/modify oxygen therapy is SaO2 is less than or equal to ninety percent (Module B3)
Does patient meet ICU admission criteria? [G] Box 8 yes to box5 Admit to ICU [F]
Does patient meet discharge criteria? [H] Box 5 no to box 9 and box 9 yes to box 10
Admit to ward [I] Discharge patient. Schedule follow-up
Complete evaluation and treat comorbid conditions [E]
Continue pharmacotherapy (Module B2)
Continue oxygen therapy (Module B3)
Is patient improving? [J] Address patient and family support and education
Does patient need mechanical ventilation? [B] Ventilate and perform CPR if indicated [C] Box 15 to box 16
Does patient meet ICU criteria? [G] Admit to ICU [F] Box 15 to box 16
Intensify treatment [L] Does the patient meet discharge criteria? [H]
Reassess in 30 minutes. Consider specialist consultation. Go to Box 13 [M] Continue treatment [K] Go to box 13 Discharge patient. Follow up.