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Obesity hypoventilation decompensation — SCE Acute Medicine MCQ

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EasyAcute Respiratory PresentationsObesity hypoventilation decompensationSCE Acute Medicine

A 45-year-old woman presents with acute breathlessness with chest symptoms. Relevant history includes respiratory disease and a relevant acute precipitant. On assessment, respiratory distress is present with abnormal oxygenation. Investigations show morning headaches, BMI 54 and acidotic hypercapnia. What is the most appropriate next step in management?

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Correct answer: E — Start controlled oxygen and non-invasive ventilation

The key discriminator is that morning headaches, BMI 54 and acidotic hypercapnia, which makes Start controlled oxygen and non-invasive ventilation the single best answer. Start anticoagulation after assessing bleeding risk is less appropriate because it does not address the dominant acute risk in the vignette; Give targeted antidote or reversal therapy would fit a different presentation or later stage of care. Give controlled oxygen and senior review and Give analgesia and antiemetic therapy are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: BTS/ICS NIV Guideline