The respiratory therapist is called to the emergency room. Chest X-ray reveals a right lower lobe consolidation. The patient is awake, but lethargic and using his accessory muscles to breathe. An ABG has been drawn. What should the respiratory therapist recommend next?

ABG results

PH: 7.24

PaCO2: 59

PaO2: 65

HCO3: 24

  1. Non-invasive mask ventilation
  2. Antibiotics
  3. 4 LPM nasal cannula
  4. Intubation and mechanical ventilation​

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4. Intubation and mechanical ventilation

Explanations


A. Incorrect. Lethargic patients cannot protect their airway. Non-invasive ventilation is contraindicated in patients who cannot protect their airway.

B. Incorrect. Ventilation is a greater priority than treating a possible RLL pneumonia.

C. Incorrect. Ventilation is a greater priority than oxygenation.

D. Correct. The patient has an acute respiratory acidosis. His accessory muscle use indicates he has an elevated work of breathing. In addition, he is lethargic which indicates he may not be able to protect his airway. Therefore, intubation and mechanical ventilation is indicated.

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