SAQ 477 – Respiratory – COPD exacerbation requiring NIV and intubation planning

A 52-year-old woman presents with 24 hours of breathlessness. She has COPD related to alpha-1 antitrypsin deficiency.

Complete the table describing the utility of venous blood gas variables in this patient.

(Marked out of 8.0)
</p> <table class="saq-prop-table"> <thead> <tr> <th>Variable</th> <th>Utility</th> </tr> </thead> <tbody> <tr> <td>pH</td> <td></td> </tr> <tr> <td>pCO2</td> <td></td> </tr> <tr> <td>pO2</td> <td></td> </tr> <tr> <td>HCO3-</td> <td></td> </tr> </tbody> </table> <p>

/ 8

List four (4) indications for bi-level positive airway pressure in this patient.

(Marked out of 4.0)

/ 4

Complete the table showing your bi-level positive airway pressure regimen.

(Marked out of 5.0)
</p> <table class="saq-prop-table"> <thead> <tr> <th>Variable</th> <th>Setting</th> </tr> </thead> <tbody> <tr> <td>Initial IPAP</td> <td></td> </tr> <tr> <td>Maximum IPAP</td> <td></td> </tr> <tr> <td>Initial EPAP</td> <td></td> </tr> <tr> <td>Maximum EPAP</td> <td></td> </tr> <tr> <td>Time to increase from initial settings</td> <td></td> </tr> </tbody> </table> <p>

/ 5

List five (5) indications for intubation in this patient.

(Marked out of 5.0)

/ 5

Complete the table for intubating this 70 kg patient.

(Marked out of 7.0)

Observation	Result
Blood pressure	100/60 mmHg
Heart rate	130/min
Respiratory rate	30/min
Temperature	37 C
GCS	15
Treatment already given	Salbutamol 10 mg nebulised

</p> <table class="saq-prop-table"> <thead> <tr> <th>Item</th> <th>Answer</th> </tr> </thead> <tbody> <tr> <td>ETT size</td> <td></td> </tr> <tr> <td>Pretreatment</td> <td></td> </tr> <tr> <td>Induction agent and dose</td> <td></td> </tr> <tr> <td>Relaxant agent and dose</td> <td></td> </tr> </tbody> </table> <p>

/ 7

List your initial ventilator settings for this patient.

(Marked out of 7.0)
</p> <table class="saq-prop-table"> <thead> <tr> <th>Setting</th> <th>Answer</th> </tr> </thead> <tbody> <tr> <td>Ventilator mode</td> <td></td> </tr> <tr> <td>Tidal volume</td> <td></td> </tr> <tr> <td>Respiratory rate</td> <td></td> </tr> <tr> <td>P(insp) if using PCV</td> <td></td> </tr> <tr> <td>PEEP</td> <td></td> </tr> <tr> <td>FiO2</td> <td></td> </tr> <tr> <td>I:E ratio</td> <td></td> </tr> </tbody> </table> <p>

/ 7

Total Score: 0 / 36

Percentage: 0%