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Acute pulmonary oedema with acidaemia — SCE Acute Medicine MCQ

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EasyAcute Cardiac PresentationsAcute pulmonary oedema with acidaemiaSCE Acute Medicine

A 69-year-old woman is assessed on the acute medical unit. She has acute heart failure with severe dyspnoea despite nitrates and diuretics. ABG shows pH 7.24, PaCO2 7.0 kPa and PaO2 8.1 kPa. 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 NICE supports NIV in cardiogenic pulmonary oedema when severe dyspnoea and acidaemia are present. Arrange urgent CT imaging before treatment 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 is not routine for every pulmonary oedema case, but acidaemia changes the balance.

Reference: NICE CG187