What is the first treatment in the hospital for people with COPD who can't breathe?

O2, medications. O2 most often 2l/min, breathing treatments with albuterol and atrovent (ipratropium) and intravenous soumedrol and in some cases antibiotics. We may have to do chest x-rays to rule out pneumonia.
Nebulizer Treatments. Usually COPD patients are treated with nebulizer treatments when they arrive in the er or hospital. These are drugs that are short acting and knonw as bronchodilators. The most common in the us is albuterol. It can be given as a short treatment or an hour long treatment. Often intravenous steroids/methylprednisolone is given at the same time although it takes much longer to have effect.
Improve airflow. The first treatment is designed to improve airflow if possible by relaxing the bronchial tubes. Swelling and spasm can often be improved with bronchodilators - medicines which relax the muscle around bronchial tubes. However, in severe circumstances, the lungs may need to be rested with mechanical ventilation and strong anti-inflammatory medications. Extra oxygen is also essential.
Numerous. One must first ascertain the pts gas exchange. If they have hypercarbia or refractory hypoxemia they will require bipap or mechanical ventilation. Usually nebulized labas and samas as well as intermediate dose steroids and antibiotics. Dvt prophylaxis an stress ulcer prophylaxis. Supplemental oxygen is adminstered to maintain a sat of>88 to 90.