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COPD exacerbation with hypercapnia — ABEM Board MCQ

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ModeratePulmonary emergenciesCOPD exacerbation with hypercapniaABEM Board

A 68-year-old man with COPD arrives with increasing dyspnea and somnolence. Triage acuity is ESI 2; BP 156/84 mm Hg, HR 112/min, RR 30/min, SpO2 84% on room air. ABG shows pH 7.25, PaCO2 68 mm Hg, PaO2 58 mm Hg. He is protecting his airway. Which of the following is the most appropriate initial action?

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Correct answer: C — Start noninvasive ventilation with controlled oxygen

Acute hypercapnic respiratory failure from COPD exacerbation is treated with noninvasive ventilation when the patient can protect the airway.

Reference: GOLD COPD guidance; ACEP airway guidance