A 72-year-old woman arrives as ESI 2 with worsening shortness of breath and COPD. BP 148/82, HR 112, RR 30, SpO2 86%. VBG shows pH 7.26 and PCO2 72

Question

A 72-year-old woman arrives as ESI 2 with worsening shortness of breath and COPD. BP 148/82, HR 112, RR 30, SpO2 86%. VBG shows pH 7.26 and PCO2 72 mm Hg; she is awake and protecting her airway. Which of the following is the most appropriate next step in management?

Accepted Answer

Start noninvasive ventilation with bronchodilators and steroids

Answer

Perform immediate cricothyrotomy

Answer

Administer thrombolysis

Answer

Discharge with oral steroids

Answer

Give high-flow oxygen targeting SpO2 100%

Hypercapnic COPD exacerbation — ABEM Board MCQ

A 72-year-old woman arrives as ESI 2 with worsening shortness of breath and COPD. BP 148/82, HR 112, RR 30, SpO2 86%. VBG shows pH 7.26 and PCO2 72 mm Hg; she is awake and protecting her airway. Which of the following is the most appropriate next step in management?