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COPD exacerbation with hypercapnic respiratory failure — RCPSC EM MCQ

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ModerateRespiratory emergenciesCOPD exacerbation with hypercapnic respiratory failureRCPSC EM

A 72-year-old with COPD presents with drowsiness and worsening dyspnoea. Respiratory rate is 30/min, oxygen saturation is 86% on 10 L/min oxygen and chest auscultation shows diffuse wheeze. ABG shows pH 7.24, PaCO2 78 mmHg and PaO2 62 mmHg. What is the most likely diagnosis?

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Correct answer: A — Acute hypercapnic respiratory failure from COPD exacerbation

Acidaemia with markedly raised PaCO2 in a wheezy COPD patient indicates acute hypercapnic respiratory failure. Controlled oxygen, bronchodilators, steroids, antibiotics if indicated and NIV are central management steps.

Reference: Canadian Thoracic Society COPD guidance; CAEP respiratory care resources