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14th August 2024
You are asked to see a 67-year-old lady on the ward who has been admitted with an exacerbation of COPD
You are asked to see a 67-year-old lady on the ward who has been admitted with an exacerbation of COPD. The nursing staff have noted that she has become less responsive over the preceding few hours. She has been receiving nebulisers driven by oxygen during the day to treat a persistent wheeze. On examination, she is drowsy with laboured breathing. Her GCS is 7 (E2V2M3). Peripheral oxygen saturation is 98%.
An arterial blood gas demonstrates:
| pH | 7.19 | (7.35-7.45) |
| pO₂ | 18.9 | (10-12) |
| pCO₂ | 10.3 | (4.5-6) |
| Na⁺ | 137 | (135-145) |
| K⁺ | 4.9 | (3.5-5.5) |
| HCO₃⁻ | 13.6 | (22-26) |
| Lac | 3.8 | (0-2) |
| Glu | 8.7 | (4-7.8) |
Which is the single most appropriate treatment option?
Select the SINGLE most appropriate option from the list below. Select ONE option only.
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