NREMT Paramedic Cognitive ExamAirway, Respiration & VentilationHard
A 65-year-old male with a history of COPD is experiencing an acute exacerbation. He is alert but fatigued, with a respiratory rate of 26 breaths/min and shallow. His SpO2 is 87% on 2 L/min nasal cannula. You apply a non-rebreather mask at 10 L/min, and his SpO2 improves to 90%. What is the most appropriate next step in his respiratory management?
- APrepare for immediate endotracheal intubation.
- BConsider applying Continuous Positive Airway Pressure (CPAP).
- CIncrease the non-rebreather mask flow rate to 15 L/min.
- DMaintain the non-rebreather mask and continue transport.
Show answer & explanationAnswer & explanation
Correct answer: B. Consider applying Continuous Positive Airway Pressure (CPAP).
The patient's persistent fatigue, shallow respirations, and a SpO2 of 90% (which is within the target for COPD but still low given the acute exacerbation) suggest that he may need more than just supplemental oxygen. CPAP can help reduce the work of breathing, improve oxygenation, and prevent the need for invasive ventilation in COPD exacerbations.
Why the other options are wrong
- A. Intubation should be considered only if CPAP fails or if the patient's condition rapidly deteriorates to respiratory failure; less invasive measures are preferred first.
- C. Increasing the flow on a non-rebreather mask will not provide the positive pressure support needed to improve ventilation and reduce work of breathing.
- D. While his SpO2 is within range, his fatigue and shallow breathing indicate ongoing respiratory distress that warrants further intervention.
CPAP for COPD Exacerbation
CPAP applies continuous positive airway pressure to support ventilation, reduce work of breathing, and improve oxygenation in patients with COPD exacerbations, often preventing the need for intubation.
- Reduces work of breathing.
- Improves oxygenation.
- Non-invasive ventilation.
Memory trick: When oxygen alone 'falls flat', CPAP is the 'next step on the mat'.