A 55-Year-Old Male with Acute Dyspnea Is Admitted to the Hospital

Multiple Choice

A 55-year-old male with acute dyspnea is admitted to the hospital. He is alert and oriented. His physical examination reveals: heart rate 120 beats/min and regular; blood pressure 146/88 mm Hg; temperature 38° C; respiratory rate 28 breaths/min shallow and labored. Breath sounds are decreased throughout with fine late crackles on inspiration, chest expansion is decreased in both bases. The patient is not coughing. The ABG on room air is: pH 7.52; PaCO₂ 30 mm Hg; PaO₂ 42 mm Hg; Hb-O₂ 80%; HCO₃^- 24 mEq/L. This patient is retired after working in a steel factory for 38 years and he has a 50-pack-year history of smoking. The most appropriate action for the respiratory therapist to take is which of the following?

A) Intubate and initiate positive-pressure ventilation.
B) Initiate noninvasive positive pressure ventilation.
C) Administer oxygen via a high flow nasal cannula.
D) Initiate bronchodilator and mucolytic therapy.