A 71-year-old man with severe COPD presents CTAS 2 with worsening dyspnoea and drowsiness. RR is 32, SpO2 is 86% on 2 L nasal oxygen, BP is 156/84,

Question

A 71-year-old man with severe COPD presents CTAS 2 with worsening dyspnoea and drowsiness. RR is 32, SpO2 is 86% on 2 L nasal oxygen, BP is 156/84, and ABG shows pH 7.24, PaCO2 78 mmHg, HCO3 31 mmol/L. Chest X-ray shows hyperinflation without consolidation. What is the most appropriate next step?

Accepted Answer

Start non-invasive ventilation with controlled oxygen and bronchodilator therapy

Answer

Give intravenous furosemide as first-line therapy

Answer

Proceed directly to rapid sequence intubation

Answer

Discharge after nebulised salbutamol if the wheeze improves

Answer

Increase oxygen to a non-rebreather mask targeting SpO2 100%

COPD exacerbation with hypercapnic respiratory failure — RCPSC EM MCQ

A 71-year-old man with severe COPD presents CTAS 2 with worsening dyspnoea and drowsiness. RR is 32, SpO2 is 86% on 2 L nasal oxygen, BP is 156/84, and ABG shows pH 7.24, PaCO2 78 mmHg, HCO3 31 mmol/L. Chest X-ray shows hyperinflation without consolidation. What is the most appropriate next step?