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ABG interpretation before NIV — SCE Acute Medicine MCQ

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ModerateProcedural Knowledge in Acute MedicineABG interpretation before NIVSCE Acute Medicine

A 45-year-old woman presents with a procedure-related acute decision. Relevant history includes coagulation, imaging, respiratory physiology or procedural risk. On assessment, bedside findings determine whether the procedure is safe and urgent. Investigations show hyperoxia with pH 7.22 and PaCO2 11.5 in COPD. What is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Reduce oxygen to target range and start NIV

The key discriminator is that hyperoxia with pH 7.22 and PaCO2 11.5 in COPD, which makes Reduce oxygen to target range and start NIV the single best answer. Arrange urgent specialist referral is less appropriate because it does not address the dominant acute risk in the vignette; Give intravenous fluids with reassessment would fit a different presentation or later stage of care. Provide supportive care and close monitoring and Start broad-spectrum intravenous antibiotics 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 Oxygen Guideline; BTS/ICS NIV Guideline