A 68-year-old with COPD presents with increasing dyspnoea and drowsiness. RR 30, SpO2 84% on room air, pH 7.24, PaCO2 72 mmHg, HCO3 31 mmol/L, and

Question

A 68-year-old with COPD presents with increasing dyspnoea and drowsiness. RR 30, SpO2 84% on room air, pH 7.24, PaCO2 72 mmHg, HCO3 31 mmol/L, and chest X-ray shows hyperinflation without consolidation. What is the most appropriate initial management?

Accepted Answer

Controlled oxygen, bronchodilators, steroids, antibiotics when indicated, and non-invasive ventilation

Answer

Heliox with no bronchodilator or steroid therapy

Answer

Furosemide and nitrates as first-line therapy

Answer

High-flow oxygen to target SpO2 100% with discharge after nebulisers

Answer

Immediate rapid sequence intubation without a trial of ventilatory support

COPD exacerbation with hypercapnic respiratory failure — RCPSC EM MCQ

A 68-year-old with COPD presents with increasing dyspnoea and drowsiness. RR 30, SpO2 84% on room air, pH 7.24, PaCO2 72 mmHg, HCO3 31 mmol/L, and chest X-ray shows hyperinflation without consolidation. What is the most appropriate initial management?