Would you treat a patient with COPD who is in severe respiratory distress, using accessory muscle use, cyanotic around the lips, no wheezes, but mild crackles in the bases with 
1. Salbutamol, dexamethasone, and then CPAP?  
2. Or just Dexamethasone and then CPAP? 
3. Or just Salbutamol and CPAP?  
According to the companion Doc for CPAP it states that "CPAP should be considered as an additive therapy to the bronchoconstriction (specifically COPD exacerbation) or acute cardiogenic pulmonary edema medical directive, not a replacement."  
Please clarify for me. Thanks!  

In a patient with severe respiratory distress, with suspected COPD exacerbation as the cause, you would treat per the Bronchconstriction and CPAP Medical Directives. The priority treatment would be Salbutamol and CPAP.  

Salbutamol will aid in acute bronchoconstriction management. 

CPAP will also aid in acute bronchoconstriction but should not be used in isolation without salbutamol. 

Dexamethasone will not provide immediate relief. In fact, it will not start to show benefit until 1 hour after administration. Therefore, it can be given once the other treatments are ongoing, butut, should not be prioritized until (of if) you have the ability to safely give it and not sacrifice other life-saving treatments. 

Airway/Breathing,Bronchoconstriction,Continuous Positive Airway Pressure (CPAP)

Bronchoconstriction, Chronic Obstructive Pulmonary Disesase, COPD, CPAP, Dexamethasone, Medication administration, Priorities, Respiratory distress

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