SAQ 539 – Respiratory – COPD exacerbation on NIV with complication

A 65-year-old woman presents with recurrent COPD exacerbation that worsened overnight. She is alert but tired. Her ABG and subsequent CXR are shown below.

Observation	Result
Initial HR	130/min
Initial BP	105/45 mmHg
Initial SpO2	87% on 15 L Hudson mask
Initial RR	50/min
Initial temperature	37.6 C
pH	7.21
pCO2	70 mmHg
pO2	75 mmHg
HCO3	27 mmol/L
Base excess	-1.5
Lactate	1.9 mmol/L
Post-NIV HR	135/min
Post-NIV BP	75/45 mmHg
Post-NIV SpO2	80% on NIV FiO2 1.0
Post-NIV RR	60/min

List four (4) indications and four (4) contraindications for non-invasive ventilation in any patient.

(Marked out of 8.0)
</p> <table class="saq-prop-table"> <thead> <tr> <th>Indication</th> <th>Contraindication</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

What form of NIV would you recommend for this patient, and why?

(Marked out of 2.0)

/ 2

State three (3) initial settings for that NIV mode and justify each.

(Marked out of 6.0)
</p> <table class="saq-prop-table"> <thead> <tr> <th>Setting</th> <th>Justification</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> </tbody> </table> <p>

/ 6

A few minutes after starting NIV, she deteriorates as the CXR is taken. What NIV complication has she suffered?

(Marked out of 1.0)

/ 1

State four (4) emergent management tasks that should be performed.

(Marked out of 4.0)

/ 4

List four (4) other complications that may occur with NIV.

(Marked out of 4.0)

/ 4

Total Score: 0 / 25

Percentage: 0%