MedBugs: SAQ #292

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Case: COPD exacerbation

A 75-year-old man presents with severe shortness of breath due to an infective exacerbation of COPD. You are considering NIV as part of his management.

1. List four absolute contraindications to NIV for COPD in the Emergency Department. 4 marks

After 1 hour of BiPAP an ABG is performed: FiO2 0.5 pH 7.26 pCO2 86 pO2 52 HCO3 38 BE 7.1 You note that this result is very similar to the ABG taken on arrival.

2. List the pathological processes evident on the arterial blood gas after one hour of BiPAP, giving supportive evidence. 4 marks

3. List and justify the changes you would make to his NIV parameters based on the ABG. 2 marks

4. What are the evidence-based benefits of BiPAP for treatment of COPD? 2 marks

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Case: COPD exacerbation

1. List four absolute contraindications to NIV for COPD in the Emergency Department. 4 marks

2. List the pathological processes evident on the arterial blood gas after one hour of BiPAP, giving supportive evidence. 4 marks

3. List and justify the changes you would make to his NIV parameters based on the ABG. 2 marks

4. What are the evidence-based benefits of BiPAP for treatment of COPD? 2 marks

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