A 72-year-old man with a 50-pack-year smoking history and COPD (GOLD Stage 3, FEV1 32% predicted) presents to the emergency department with acute worsening dyspnea over 2 days. He reports increased sputum production with a yellow tint. Vital signs show respiratory rate 28/min, heart rate 105/min, blood pressure 148/92 mmHg, and O2 saturation 88% on room air. Physical examination reveals diffuse wheezing and use of accessory muscles. Chest X-ray shows hyperinflation without focal infiltrates or pneumothorax. Arterial blood gas on room air reveals pH 7.29, PaCO2 62 mmHg, PaO2 58 mmHg, and HCO3− 30 mEq/L. The patient has a history of anxiety and requests pain control. Which of the following should be avoided in the acute management of this exacerbation?
- A)Intravenous methylprednisolone
- B)Nebulized albuterol and ipratropium bromide
- C)Intravenous morphine for dyspnea and anxietyGABARITO
- D)Noninvasive positive pressure ventilation (NIPPV)
- E)Empiric broad-spectrum antibiotics
Explicação
Intravenous morphine should be avoided in this acute COPD exacerbation with hypercapnic respiratory failure (PaCO2 62 mmHg, pH 7.29). Opioids and sedating medications cause respiratory depression and can worsen CO2 retention, precipitating acute respiratory fa... Ver explicação completa e trilha adaptativa →