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COPD exacerbation with hypercapnic acidosis — SCE Acute Medicine MCQ

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EasyAcute Respiratory PresentationsCOPD exacerbation with hypercapnic acidosisSCE Acute Medicine

A 71-year-old man is assessed on the acute medical unit. He has severe COPD, drowsiness and increased sputum. ABG on controlled oxygen shows pH 7.26, PaCO2 9.2 kPa, PaO2 7.3 kPa and bicarbonate 34 mmol/L. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: C — Start non-invasive ventilation on the acute unit

Start non-invasive ventilation on the acute unit is the best answer because acute-on-chronic hypercapnic respiratory failure with acidaemia is an indication for acute NIV after initial medical therapy. Give intravenous lorazepam and protect the airway is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Controlled oxygen targets and repeat ABGs are central in COPD exacerbations.

Reference: BTS/ICS acute NIV guideline; NICE NG115