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COPD exacerbation with hypercapnic respiratory failure — ABEM Board MCQ

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ModeratePulmonary emergenciesCOPD exacerbation with hypercapnic respiratory failureABEM Board

A 67-year-old man with COPD presents as triage level 2 with worsening dyspnea and somnolence. Vitals show RR 30/min and oxygen saturation 86%; ABG shows pH 7.26, PaCO2 72 mm Hg, PaO2 58 mm Hg. He is cooperative and protecting his airway. Which of the following is the most appropriate next step in management?

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Correct answer: C — Start bilevel noninvasive ventilation with bronchodilators and steroids

NIV reduces intubation risk in COPD exacerbation with acute hypercapnic respiratory acidosis when the patient can protect the airway.

Reference: GOLD COPD guidance; ABEM EM Model