A 74-year-old man was brought to the Emergency Department with progressive dyspnea and low-grade fever for 3 days. He is heavy smoker with more than 60 pack-years. He is slightly confused. His Oxygen saturation is 92% on room air, his Chest X-ray is unremarkable, his Arterial blood gas: pH 7.30, PaO2: 65mmHg, PaCO2 70 mmHg, HCO3 30 mmol/L. He received bronchodilators and systemic steroids. Which of the following is the best next step in his management?
سؤال مجاني 3 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
المصادر مختلفة. ملفات الدفعة فيها إجابتين، وما نرجّح وحدة على الثانية. سبب كل وحدة في الشرح تحت:
- إجابة: B. Non-Invasive Positive Pressure Ventilation
- إجابة ثانية: C. Intubation and mechanical ventilation
This is acute hypercapnic respiratory failure in an AECOPD (pH 7.30, PaCO2 70). NIPPV (BiPAP) is the preferred ventilation strategy and lowers the need for intubation. Mild confusion from hypercapnia is not a contraindication; intubation is for NIPPV failure, coma, or loss of airway protection. Oxygen should target 88-92%, not >95% (risk of CO2 retention), and bicarbonate is not used. The cohort summaries differ here: one gives NPPV for altered mental status, another says intubation (C) for altered consciousness. Know both.
ليش كل خيار صح أو غلط
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A
ليش غلط
Oxygen in AECOPD is targeted at 88-92%, not above 95%, so this is not the best next step.
✓ COPD.pdf · p. 11 -
B
ليش صح
Supported by the Pulmonology summary: a severe exacerbation (respiratory acidosis, altered mental status) is managed with NPPV/BiPAP first. The Asthma and COPD summary differs and lists altered consciousness under intubation.
✓ Pulmonology 🫁.pdf · p. 11 -
C
ليش صح
Supported by the Asthma and COPD summary: NIV needs a conscious, alert patient, and altered level of consciousness is listed for invasive ventilation. The Pulmonology summary differs and puts NPPV first.
✓ Asthma and COPD.pdf · p. 9 -
D
ليش غلط
Antibiotics are given when criteria are met (all 3 cardinal symptoms, purulent sputum plus one more, or mechanical ventilation); they are not the next step for his respiratory acidosis.
✓ COPD.pdf · p. 12
- المصدر
- COPD.pdf · p. 11
Pulmonology 🫁.pdf · p. 11 - المحاضرة
- COPD Exacerbation · Pulmonology · Module B
- ظهر في
- Respi bank