How do you assess and manage an acute exacerbation of COPD presenting with confusion and SpO2 of 84%?

Question

Accepted Answer

Confusion with hypoxia in COPD raises concern for type 2 respiratory failure. ABCDE with controlled oxygen using a Venturi mask starting 24-28% titrated to SpO2 88-92%. I would obtain an ABG within 30 minutes. Treatment includes back-to-back nebulised salbutamol 5mg and ipratropium 500mcg driven by air, oral prednisolone 30mg for 5 days, and antibiotics if purulent sputum or CXR consolidation. If the ABG shows respiratory acidosis pH less than 7.35 with hypercapnia after one hour of optimal medical therapy, I would commence NIV with BiPAP on the respiratory ward or HDU. I would have an early ceiling of care discussion with the patient and family, and document clearly.

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