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COPD exacerbation — DIPIMC MCQ

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HardMedical EmergenciesCOPD exacerbationDIPIMCDipIMC

A patient with COPD is acutely breathless and becomes drowsy after uncontrolled high-concentration oxygen. Saturation is 99%, ventilation is present and immediate blood-gas analysis is unavailable. What oxygen strategy is appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Use controlled oxygen targeting 88–92% while assessing hypercapnia

The best answer is “Use controlled oxygen targeting 88–92% while assessing hypercapnia”. In a patient at risk of hypercapnic respiratory failure, BTS guidance supports controlled oxygen targeting 88–92% pending blood-gas assessment. New drowsiness demands urgent ventilatory assessment and escalation, not abrupt withdrawal of oxygen. Excess oxygen can worsen hypercapnia in susceptible patients, but untreated hypoxaemia is also dangerous; titration, monitoring and timely ventilatory support are the safe approach.

Reference: British Thoracic Society, Guideline for oxygen use: https://www.brit-thoracic.org.uk/quality-improvement/guidelines/emergency-oxygen/