A 55-year-old male with acute dyspnea is admitted to the hospital. He is alert and oriented

His physical examination reveals: heart rate 120 beats/min and regular; blood pressure 146/88 mm Hg; temperature 38° C; respiratory rate 28 breaths/min shallow and labored. Breath sounds are decreased throughout with fine late crackles on inspiration, chest expansion is decreased in both bases. The patient is not coughing. The ABG on room air is: pH 7.52; PaCO2 30 mm Hg; PaO2 42 mm Hg; Hb-O2 80%; HCO3? 24 mEq/L. This patient is retired after working in a steel factory for 38 years and he has a 50-pack-year history of smoking. The most appropriate action for the res-piratory therapist to take is which of the following?
a. Intubate and initiate positive-pressure ventilation.
b. Initiate noninvasive positive pressure ven-tilation.
c. Administer oxygen via a high flow nasal cannula.
d. Initiate bronchodilator and mucolytic therapy.

ANS: C
According to the arterial blood gas (ABG) this patient is able to move air as evidenced by a par-tial pressure of carbon dioxide (PaCO2) of 30 mm Hg (respiratory alkalosis); therefore intubation and artificial ventilation are not necessary. The patient does not require noninvasive positive pressure ventilation (NPPV), because he is breathing. The patient does not seem to have evidence of requiring a bronchodilator and a mucolytic. The patient does, however, have moderate hy-poxemia. Since the patient is not a carbon dioxide (CO2) retainer, a high concentration of oxygen may be applied in the form of high flow nasal cannula.