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COPD exacerbation with hypercapnic failure — ACEM Fellowship MCQ

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ModerateRespiratory emergenciesCOPD exacerbation with hypercapnic failureACEM Fellowship

A 71-year-old man presents to a Hobart ED, triage category 2, with worsening dyspnoea and purulent sputum. RR 30, SpO2 86% on air, pH 7.28, pCO2 72 mmHg after controlled oxygen. He is alert but using accessory muscles. What is the most appropriate management?

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Correct answer: D — Start non-invasive ventilation with controlled oxygen

Acidotic hypercapnia despite controlled oxygen in COPD is an indication for NIV unless contraindicated.

Reference: eTG acute exacerbation COPD; ACEM respiratory curriculum