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 BOF 73

 

   

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BOF: 73

A 68 year old male who is know to have chronic obstructive pulmonary disease presents with a history of cough productive of purulent sputum and breathlessness. He has been on salbutamol and ipratropium inhalers and his GP has recently treated him with a course of steroids and antibiotics. He continues to smoke 20 cigarettes a day,

On examination he looks cyanosed and breathless, he has a flapping tremor, his pulse rate is 120 beats per minute irregularly irregular, he has a loud P2 on auscultation and over his lung fields there are scattered rhonchi and crepitations.

There is bilateral ankle oedema.

Chest X-ray does not show a consolidation

Hb 16.5 g/dL

WBC 18 x109 /L

Platelets 450

Urea 9 mmol/L

Sodium 138 mmol/L

Potassium 3.8 mmol/L

Blood gases pH 7.2, PaCO2 8.4 kPa, PaO2 6.3 kPa

ECG shows atrial fibrillation

In this patient which one of the following interventions would be of greatest benefit to the patient?

a)      Intravenous diuretics

b)      Aminophylline infusion

c)      Intravenous antibiotics

d)     Bi-level Positive Airway Pressure

e)      Intravenous amiodarone

 

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