NREMT Paramedic Cognitive ExamAirway, Respiration & VentilationMedium
A 55-year-old male with a history of chronic bronchitis presents with acute onset of severe dyspnea, pursed-lip breathing, and a productive cough. His respiratory rate is 28 breaths/min, SpO2 is 89% on room air, and he has diffuse wheezing. Which of the following interventions is most appropriate to improve his oxygenation and ventilation?
- AHigh-flow nasal cannula at 15 L/min
- BNon-rebreather mask at 10 L/min
- CContinuous Positive Airway Pressure (CPAP)
- DEndotracheal intubation with mechanical ventilation
Show answer & explanationAnswer & explanation
Correct answer: C. Continuous Positive Airway Pressure (CPAP)
The patient's presentation with chronic bronchitis, severe dyspnea, pursed-lip breathing, and wheezing, along with hypoxemia, indicates an exacerbation of COPD. CPAP can improve oxygenation, reduce the work of breathing, and help recruit alveoli without the invasiveness of intubation.
Why the other options are wrong
- A. High-flow nasal cannula may not provide sufficient ventilatory support for severe dyspnea.
- B. A non-rebreather mask provides oxygen but does not offer the positive pressure support needed to improve ventilation and reduce work of breathing in severe COPD exacerbations.
- D. Endotracheal intubation is a last resort due to its invasiveness and associated risks; less invasive options like CPAP should be tried first.
CPAP for COPD Exacerbation
Continuous Positive Airway Pressure (CPAP) provides constant positive pressure to the airway, helping to keep alveoli open, reduce work of breathing, and improve gas exchange in COPD exacerbations.
- Reduces work of breathing.
- Improves oxygenation and ventilation.
- Avoids invasive intubation.
Memory trick: CPAP is like a 'CAP' that keeps your airways 'open' and 'pressurized'.