A 68-year-old woman with a history of advanced chronic obstructive pulmonary disease comes to the emergency department with COPD exacerbation. She is given additional supplemental oxygen, intravenous antibiotics, methylprednisolone, and 2 treatments of nebulized ipratropium and salbutamol. Following these measures, she remains dyspneic and uses accessory muscles. Results of ABG are pH 7.32, PCO2 60 mm Hg, and PO2 52 mm Hg. Which of the following is the best next step in management of this patient?
سؤال مجاني 10 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
الإجابة: C. Start non-invasive positive pressure ventilation
Despite full medical therapy she has persistent respiratory distress with acute hypercapnic respiratory acidosis (pH 7.32, PaCO2 60). Respiratory acidosis (PaCO2 ≥45 and pH ≤7.35) with accessory-muscle use is the indication for NIPPV (BiPAP), the preferred ventilation strategy in AECOPD. Intubation is a last resort, used only if NIPPV fails or is not tolerated; IV theophylline is not recommended, and reducing oxygen is wrong since she is hypoxaemic (PO2 52).
ليش كل خيار صح أو غلط
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A
ليش غلط
Theophylline has a controversial role in COPD and a narrow therapeutic index, so it is not the evidence-based next step.
✓ Step Up To Medicine 6th Edition 2024 (COPD).pdf · p. 7 -
B
ليش غلط
Oxygen is given for hypoxemia and titrated to SpO2 88-92%; with PO2 52 she is still hypoxemic, and reducing oxygen does not treat her acidosis.
✓ COPD.pdf · p. 11 -
C
ليش صح
pH 7.32 with PaCO2 60 is respiratory acidosis (PaCO2 ≥ 45, pH ≤ 7.35), the indication for NIPPV, the preferred ventilation strategy in AECOPD with acute respiratory failure.
✓ COPD.pdf · p. 11 -
D
ليش غلط
Intubation is a last resort, used when NIPPV is not tolerated or is inadequate; NIPPV has not been tried yet.
✓ COPD.pdf · p. 12
- المصدر
- COPD.pdf · p. 11
COPD.pdf · p. 12 - المحاضرة
- COPD Exacerbation · Pulmonology · Module B
- ظهر في
- Respi bank