SAQ 403 – Respiratory – COPD NIV complicated by tension pneumothorax

A 65-year-old woman with COPD presents with dyspnoea. She is alert and oriented but fatigued. You decide to start non-invasive ventilation. There is no concern for COVID-19 infection. A few minutes after NIV starts she becomes pale and very short of breath. Her urgent chest x-ray is shown below.

Observation	Result
Initial heart rate	120/min
Initial blood pressure	110/70 mmHg
Initial oxygen saturation	80% on room air
Initial respiratory rate	40/min
Temperature	37.6 C
ABG pH	7.12
ABG pO2	75 mmHg
ABG pCO2	70 mmHg
ABG HCO3	30 mmol/L
ABG lactate	1.9 mmol/L
After NIV heart rate	130/min
After NIV blood pressure	75/50 mmHg
After NIV oxygen saturation	80% on FiO2 1.0

List four (4) indications and four (4) contraindications for NIV in any patient.

(Marked out of 8.0)
</p> <table class="saq-prop-table"> <thead> <tr> <th>Indications</th> <th>Contraindications</th> </tr> </thead> <tbody> <tr> <td>1.</td> <td></td> </tr> <tr> <td>2.</td> <td></td> </tr> <tr> <td>3.</td> <td></td> </tr> <tr> <td>4.</td> <td></td> </tr> </tbody> </table> <p>

/ 8

State the NIV mode and starting settings you would use.

(Marked out of 4.0)
</p> <table class="saq-prop-table"> <thead> <tr> <th>Setting</th> <th>Value</th> </tr> </thead> <tbody> <tr> <td>Mode</td> <td></td> </tr> <tr> <td>IPAP</td> <td></td> </tr> <tr> <td>EPAP</td> <td></td> </tr> <tr> <td>FiO2</td> <td></td> </tr> </tbody> </table> <p>

/ 4

State the diagnosis shown on the x-ray.

(Marked out of 1.0)

/ 1

List four (4) urgent management steps.

(Marked out of 4.0)

/ 4

Total Score: 0 / 17

Percentage: 0%