Question

A 71-year-old with severe COPD, baseline CO₂ retention, presents with acute-on-chronic hypercapnic respiratory failure. ABG: pH 7.25, PaCO₂ 72. After NIV trial, mental status worsens and pH falls to 7.20. Next step?

Accepted Answer

Intubate and mechanically ventilate

Answer

Continue NIV longer

Answer

Give acetazolamide and continue NIV

Answer

Increase oxygen to SpO₂ 100%

Answer

Start morphine for dyspnoea

Practice question

A 71-year-old with severe COPD, baseline CO₂ retention, presents with acute-on-chronic hypercapnic respiratory failure. ABG: pH 7.25, PaCO₂ 72. After NIV trial, mental status worsens and pH falls to 7.20. Next step?