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COPD exacerbation with acute hypercapnic respiratory failure — RCPSC EM MCQ

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HardRespiratory emergenciesCOPD exacerbation with acute hypercapnic respiratory failureRCPSC EM

A 69-year-old with COPD presents with worsening dyspnoea and purulent sputum. RR is 30/min, oxygen saturation is 86% on room air, and ABG on controlled oxygen shows pH 7.25, PaCO2 72 mmHg, HCO3 31 mmol/L. What is the most appropriate initial management?

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Correct answer: B — Start non-invasive ventilation with bronchodilators, steroids, and antibiotics as indicated

Start non-invasive ventilation with bronchodilators, steroids, and antibiotics as indicated is correct: the clues indicate COPD exacerbation with acute hypercapnic respiratory failure and this option addresses the immediate ED priority. The distractors delay care, target a less likely problem, or are unsafe in this physiology.

Reference: Canadian COPD emergency practice