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NIV contraindication — SCE Acute Medicine MCQ

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ModerateProcedural Knowledge and Acute Management DecisionsNIV contraindicationSCE Acute Medicine

A 72-year-old woman is assessed on the acute medical unit. She has hypercapnic respiratory failure but is vomiting repeatedly and cannot protect her airway. She is becoming drowsy. 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: D — Request urgent senior critical care review

Request urgent senior critical care review is the best answer because inability to protect the airway and persistent vomiting make NIV unsafe and require escalation. Give isotonic crystalloid boluses with frequent reassessment 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 failure or contraindication should trigger a plan for invasive ventilation or palliation.

Reference: BTS/ICS acute NIV guideline