11th January 2024

A 74-year-old gentleman with a known history of chronic obstructive pulmonary disease presents to the Emergency Department with acute onset of shortness of breath.

A 74-year-old gentleman with a known history of chronic obstructive pulmonary disease presents to the Emergency Department with acute onset of shortness of breath. He is known to have significant bullous emphysema on a recent high-resolution CT scan. On examination, his respiratory rate is 30 breaths/min, oxygen saturations 88% on breathing air. He is taking shallow breaths with significant use of accessory muscles, but otherwise, respiratory examination is normal. 

A chest x-ray is completed, which shows bilateral hyperinflation and flattened hemidiaphragm. There is no evidence of consolidation. 

Investigations: 

Arterial blood gas on breathing air (21%) – 

pH 7.49

pC02 8.8 

p02 8.7

HC03- 33.6

Given his presentation, what is the next most appropriate step in this gentleman’s management plan? 

Select the SINGLE most appropriate option from the list below. Select ONE option only.