A 71-year-old woman with known left ventricular systolic dysfunction presents with rapidly worsening breathlessness. She is sitting upright, alert

Question

A 71-year-old woman with known left ventricular systolic dysfunction presents with rapidly worsening breathlessness. She is sitting upright, alert and able to cooperate with treatment, but can speak only in single words. Her blood pressure is 218/116 mmHg, pulse 118/min and oxygen saturation 88% despite high-concentration oxygen. She has widespread bilateral crackles and diffuse B-lines on lung ultrasound. Arterial blood gas analysis shows pH 7.26 and PaCO₂ 6.8 kPa. The ECG shows sinus tachycardia without acute ischaemic changes. Monitoring and intravenous access are established. Which initial treatment and disposition plan is most appropriate?

Accepted Answer

Start non-invasive ventilation, give intravenous furosemide and glyceryl trinitrate, and arrange level 2 care.

Answer

Start invasive ventilation, give intravenous furosemide and glyceryl trinitrate, and arrange critical-care admission.

Answer

Continue oxygen alone, give intravenous furosemide and glyceryl trinitrate, and arrange critical-care admission.

Answer

Start non-invasive ventilation, give intravenous furosemide and dobutamine, and arrange critical-care admission.

Answer

Start non-invasive ventilation, give intravenous furosemide and glyceryl trinitrate, and arrange general-ward admission.

Hypertensive acute cardiogenic pulmonary oedema with acidaemia — MRCEM SBA MCQ