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COPD exacerbation with ventilatory failure — DipIMC MCQ

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ModerateMedical EmergenciesCOPD exacerbation with ventilatory failureDipIMC

A 72-year-old woman with COPD is drowsy and cyanosed. Saturations are 78% on air, respiratory rate 10 and wheeze is minimal; relatives report increasing sputum over three days. What is the most appropriate immediate action?

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Correct answer: E — Give controlled oxygen aiming for target saturations while supporting ventilation if needed

Severe hypoxaemia in COPD must be treated; oxygen is controlled and titrated to the appropriate target range while monitoring for ventilatory failure. Withholding oxygen is dangerous. Uncontrolled high-flow oxygen without reassessment can worsen hypercapnia in susceptible patients. The pearl is that oxygen is a drug: the correct response is titration, not avoidance.

Reference: JRCALC Guidelines 2025; BTS Emergency Oxygen Guideline