A 72-year-old woman is brought to emergency department with severe community-acquired pneumonia. She is confused, and in respiratory distress, using accessory muscles to breathe. Vital signs are respiratory rate 38 bpm, SPO2 85% on 15L/min nonrebreather face mask, blood pressure 90/60 mmHg, and heart rate 120 bpm. ABG showed pH 7.18, PaCO2 65 mmHg, bicarbonate 28 mmol/L, PaO2 50 mmHg. Which of the following is the most appropriate next step?
سؤال مجاني 1 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
الإجابة: C. Endotracheal intubation and invasive mechanical ventilation
This patient has severe mixed hypoxemic/hypercapnic failure (pH 7.18, PaO2 50 on 15 L NRB) plus confusion and hypotension. Invasive ventilation is indicated for life-threatening hypoxemia, hemodynamic instability and impaired airway protection (altered mental status), which are also the reasons NIV/BiPAP is unsafe here. HFNC does not address hypercapnia, and staying on the NRB is clearly failing.
ليش كل خيار صح أو غلط
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A
ليش غلط
HFNC only improves oxygenation; it does not improve CO2 clearance, and she has severe hypercapnic acidosis and is already failing on oxygen.
✓ 11• Respiratory Failure [Notes].pdf · p. 7 -
B
ليش غلط
Non-invasive ventilation needs a patient who is conscious and alert; she is confused, so BiPAP is not appropriate.
✓ Asthma and COPD.pdf · p. 9 -
C
ليش صح
Invasive ventilation is used for life-threatening hypoxemia, severe hemodynamic instability or impaired airway protection; she has a PaO2 of 50 on a 15 L non-rebreather, BP 90/60 and confusion.
✓ COPD.pdf · p. 12 -
D
ليش غلط
A non-rebreather is for mild hypoxia not responding to a nasal cannula and is already at its maximum (100% FiO2, up to 15 L); she is at 85% on it, so it is failing.
✓ 11• Respiratory Failure [Notes].pdf · p. 7
- المصدر
- COPD.pdf · p. 12
11• Respiratory Failure [Notes].pdf · p. 8 - المحاضرة
- Pneumonia · Pulmonology · Module B
- ظهر في
- MED43 ♂ Quiz B