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Medicine NEET Jan 2020 c58768e0

A known case of COPD with acute exacerbation of symptoms. On examination patient was conscious and ale, pulse was 110 beats/ min and bilateral wheeze present. All of the following are true in the management of the patient except:

A
I/V steroids
B
Inhalation with salbutamol
C
Permissible hypercapnia allowed
D
Non invasive ventilation is contraindicated
High-Yield Explanation
Management of COPD with acute exacerbation of symptoms Non-invasive ventilationwith tight-fitting face mask is used in the management of Type 2 Respiratory failure. E.g- Exacerbations of COPD. Supplemental oxygen- Abolishes this constriction, leading to improved ventilation/perfusion ratio. ?-? High flow oxygen isnottolerated as it leads to crusting, dryness and epistaxis. While continuous therapy is required for patients who show hypoxemia at rest, intermittent treatment during specific periods may be used for patients who demonstrate intermittent hypoxemia. Management according to severity of symptoms Grade A - Bronchodilators Grade B - LABA or LAMA - If fails - LABA + LAMA Grade C - LABA + LAMA + ICS Grade D - LABA + LAMA + ICS + Roflumilast, PDE -4 inhibition

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