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A 65-year-old woman has presented with difficulty breathing. Your assessment is consistent with an acute infective exacerbation of emphysema. Arterial blood gas: FiO2 0.5, pH 7.09, pCO2 104 mmHg, pO2 74 mmHg, HCO3 34 mmol/L, Na 143 mmol/L, K 4.7 mmol/L, Cl 100 mmol/L.

1. Briefly interpret the arterial blood gas. 4 marks

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Initial vital signs: GCS 12 (E3 V4 M5), pulse 110/min, BP 125/70 mmHg, RR 45/min, Temp 38.0Β°C. You have elected to place her on non-invasive ventilation (NIV).

2. State (4) other components of your management. 4 marks

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The patient has been on NIV for several hours.

3. List (4) changes you might make to her NIV settings. Explain the indication for each. 4 marks

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