Question

A 68-year-old man with severe COPD is admitted with increasing dyspnoea, productive cough and wheeze. Despite controlled oxygen, nebulised bronchodilators and intravenous steroids, he remains drowsy. Arterial blood gases on 28% oxygen show: pH 7.28, PaCO2 8.0 kPa, PaO2 7.8 kPa, HCO3– 30 mmol/L. What is the most appropriate next step?

Accepted Answer

Start non-invasive ventilation with close monitoring

Answer

Intubation and immediate invasive mechanical ventilation on ITU

Answer

Give a bolus of intravenous sodium bicarbonate

Answer

Return him to the ward for observation on controlled oxygen

Answer

Give high-dose intravenous furosemide

Practice question