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Non-invasive ventilation failure in COPD — SCE Acute Medicine MCQ

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HardAcute Respiratory PresentationsNon-invasive ventilation failure in COPDSCE Acute Medicine

A 67-year-old man is assessed on the acute medical unit. He has COPD and remains acidotic after two hours of optimal NIV. pH is 7.18, respiratory rate is 34/min and he is increasingly agitated. 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: E — Request urgent senior critical care review

Request urgent senior critical care review is the best answer because worsening acidosis or intolerance despite NIV requires escalation and discussion about invasive ventilation or ceilings of care. Give activated charcoal within one hour 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: NIV should be actively reviewed; it is not a passive treatment.

Reference: https://www.brit-thoracic.org.uk/quality-improvement/guidelines/#acute-medicine-order-43-1