Case One Diagnosis


JV is a 61-year-old male who has presented to the emergency department with a chief complaint of shortness of breath that has gotten progressively worse over the past day or so. He has a history of COPD and was discharged from the hospital just two months ago.

Assessment in the ED reveals the following: respiratory rate 32 and slightly labored, temperature 98.8F F, SpO2 (on room air) 86%. He is alert and oriented; he has an occasional nonproductive cough. Continue the exam using the auscultation and blood pressure tab.
Arterial blood gases are obtained with the following data:
pH 7.28; PaO2 49 (on room air)
PaCO2 74; SaO2 85%
HCO3 34; Hgb 16.4

The patient is given three aerosol treatments via small volume nebulizer with 2.5 mg albuterol plus 0.5 mg ipratropium with little change in his condition.

Based on the above data, which of the following is the next best step?

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