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COPD exacerbation with hypercapnic respiratory failure — RCPSC EM MCQ

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HardRespiratory emergenciesCOPD exacerbation with hypercapnic respiratory failureRCPSC EM

A 74-year-old man with COPD is brought with somnolence and dyspnoea. Respiratory rate is 30/min, oxygen saturation is 86% on 2 L, ABG shows pH 7.26, PaCO2 72 mmHg, HCO3 31 mmol/L, and chest radiograph shows hyperinflation without pneumonia. What is the most likely diagnosis?

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Correct answer: E — COPD exacerbation with acute hypercapnic respiratory failure

Acidaemia with markedly elevated PaCO2 in a COPD patient with somnolence indicates acute hypercapnic respiratory failure due to COPD exacerbation.

Reference: Canadian Thoracic Society COPD guidance; CAEP respiratory emergency practice