A 72-year-old with COPD has 5 days of worsening productive cough and dyspnoea despite more ipratropium and salbutamol. T 38, RR 32, HR 102. ABG: pH 7.25, PCO2 58, HCO3 26, SpO2 89%. Diffuse wheeze. What is the best course of action?
سؤال مجاني 1 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
الإجابة: B. Non-invasive ventilation and systemic corticosteroids
This is an infective COPD exacerbation with acute hypercapnic respiratory acidosis (pH 7.25, PaCO2 58) and tachypnoea despite bronchodilators. Respiratory acidosis is the indication for NIPPV, and hospitalised exacerbations need systemic corticosteroids. Oxygen and admission alone does not treat the acidosis, and CXR or sputum culture are investigations that would not be the best next action in a patient in respiratory failure.
ليش كل خيار صح أو غلط
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A
ليش غلط
Oxygen (target SpO2 88-92%) and admission are not enough on their own: with pH 7.25 and PaCO2 58 he meets the NIPPV indication (respiratory acidosis), the preferred strategy for improving oxygenation and acidosis in AECOPD.
✓ COPD.pdf · p. 11 -
B
ليش صح
In acute respiratory failure, non-invasive ventilation improves gas exchange and reduces work of breathing and the need for intubation; systemic corticosteroids improve FEV1 and shorten recovery.
✓ COPD.pdf · p. 12 -
C
ليش غلط
CXR is the best initial test to rule out pneumonia, but AECOPD is a clinical diagnosis, and with pH 7.25 and PaCO2 58 he already meets the NIPPV indication (respiratory acidosis); imaging alone does not treat that.
✓ COPD.pdf · p. 11 -
D
ليش غلط
The initial studies listed for AECOPD are ABG and CXR, and his ABG already shows respiratory acidosis (pH 7.25, PaCO2 58), the indication for NIPPV; a sputum Gram stain and culture does not treat that.
✓ COPD.pdf · p. 11
- المصدر
- COPD.pdf · p. 11
COPD.pdf · p. 12
Step Up To Medicine 6th Edition 2024 (COPD).pdf · p. 11 - المحاضرة
- COPD Exacerbation · Pulmonology · Module B
- ظهر في
- MED41 ♀ EOM B