Put on the mask

 

This SAQ is worth 8 marks

A 75 year old man is brought to your ED with severe shortness of breath. You have assessed him to have an infective exacerbation of COPD. You are considering non-invasive ventilation (NIV) as part of his management.

Question 1.
List 4 contra-indications to NIV for COPD in the ED. (2 marks)


1. ___________________________________________________________________________________________

2. ___________________________________________________________________________________________

3. ___________________________________________________________________________________________

4. ___________________________________________________________________________________________



Question 1.
After one hour of bi-level NIV, an arterial blood gas is performed:

FiO2 0.5
pH 7.26 mmHg (7.35 – 7.45)
pCO2  86 mmHg (35 – 45)
pO2 52 mmHg (60 – 100)
HCO3 38 mmol/L (24 – 34)
BE 7.1 mmol/L (-3 – 3)

You note that this result is very similar to the arterial blood gas performed on arrival.

List the pathological processes evident on the arterial blood gas, giving supportive evidence. (4 marks)


______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________



Question 1.
List the changes you would make to his NIV parameters as a result of the above findings. (2 marks)


________________________________________________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________



 

This SAQ is worth 8 marks

A 75 year old man is brought to your ED with severe shortness of breath. You have assessed him to have an infective exacerbation of COPD. You are considering non-invasive ventilation (NIV) as part of his management.

Question 1.
List 4 contra-indications to NIV for COPD in the ED. (2 marks)

Decreased level consciousness
Not initiating own breaths
Vomiting
Large haemoptysis
Facial abnormalities
Pt intolerance
Not appropriate level of care

Question 1.
After one hour of bi-level NIV, an arterial blood gas is performed:

FiO2 0.5
pH 7.26 mmHg (7.35 – 7.45)
pCO2  86 mmHg (35 – 45)
pO2 52 mmHg (60 – 100)
HCO3 38 mmol/L (24 – 34)
BE 7.1 mmol/L (-3 – 3)

You note that this result is very similar to the arterial blood gas performed on arrival.

List the pathological processes evident on the arterial blood gas, giving supportive evidence. (4 marks)

Acute on chronic respiratory acidosis – raised CO2, acidaemia indicates acute, but pH not low enough for CO2 to be solely acute – therefore chronic process with chronic metabolic compensation

Metabolic compensation – raised HCO3 and BE, chronic process



Question 1.
List the changes you would make to his NIV parameters as a result of the above findings. (2 marks)

Increase iPAP - to increase TV and hence ventilation – to remove CO2

Increase FiO2 or increase PEEP – to improve O2 (accept either but not both)

 

5.5/8 to pass corrects to 6.5/10 




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Comments:

Advanced Health Directive Stating "Not for Intubation, Resuscitation or NIV"

VIet Tran at 22:15 17 Jun 2016  

add high A-a gradient as third pathological process

Mahamudur Hassan at 21:19 10 Feb 2016  

also pneumothorax as contraindication?

Suzi Hamilton at 16:14 29 Oct 2015