For a COPD patient who is hypoxemic with a PaO2 of 55, what should be done?

• A. Prepare for intubation
• B. Increase oxygen to 100% without ventilation
• C. Start diuretics
• D. Bronchodilator therapy only

Answer: (A)

When a COPD patient is hypoxemic with a PaO2 of 55 mmHg, the immediate concern is ventilatory failure and the need to secure the airway. In COPD, oxygen therapy must be used carefully to avoid worsening CO2 retention, so simply pushing oxygen to 100% without addressing ventilation is risky. A PaO2 this low signals significant gas-exchange impairment and the potential for rapid deterioration, especially if there's fatigue, rising CO2, or confusion. Preparing for intubation and initiating mechanical ventilation allows you to support both oxygenation and ventilation, correct acidemia if present, and protect the airway as the patient stabilizes.

Oxygen alone without ventilation does not address the underlying ventilatory failure and can worsen hypercapnia in COPD. Diuretics would help only if there's fluid overload contributing to dyspnea, not to the acute hypoxemia. Bronchodilator therapy helps bronchodilation but, by itself, does not resolve the need for airway protection and ventilatory support when PaO2 is this low.