Question

A 70-year-old man with severe COPD (FEV1 35% predicted) presents with a 2-day history of increased breathlessness, cough and green sputum. On examination he is using accessory muscles and has widespread wheeze. Observations: respiratory rate 28 breaths per minute, oxygen saturation 86% on air, BP 138/76 mmHg and pulse 104 beats per minute. What is the most appropriate initial oxygen strategy?

Accepted Answer

Venturi mask delivering 24–28% oxygen aiming SpO2 88–92%

Answer

High-flow oxygen via non-rebreathe mask to 15 L/min aiming SpO2 100%

Answer

No oxygen should be given due to risk of hypercapnia

Answer

Nasal cannulae at 2 L/min aiming SpO2 95–98%

Answer

Non-invasive ventilation immediately without oxygen

Practice question