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  1. http://www.alevitrasp.com QuiCk Hit If a patient presents with COPD exacerbation the following steps are appropriate CXR agonist and anticholin ergic inhalers Systemic corticosteroids antibiotics Supplemental oxygen Noninvasive positive pressure ventilation NPPV if needed see Clinical Pearl QuiCk Hit Signs of acute severe asth ma attacks Tachypnea diaphoresis wheezing speaking in incomplete sentences and use of accessory muscles of respiration Paradoxic movement of the abdomen and dia phragm on inspiration is sign of impending respira tory failure. proogemy

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