Drowsy COPD Exacerbation: A Clinical Case
A branching clinical case simulation for a patient presenting with increasing breathlessness and drowsiness for 24 hours. Take a history, examine, investigate, diagnose and treat while the patient responds to every decision, then see the score by clinical domain with the reasoning for each mark.
Year 5hard20 min6 stages
- Patient
- 69 years, male
- Presenting complaint
- Increasing breathlessness and drowsiness for 24 hours
- Decision stages
- History, Examination, Investigations, Diagnosis, Treatment, Monitoring
The presentation
You are in the emergency department of a district general hospital. A 69-year-old man with known COPD attended 1 hour ago with an exacerbation. Despite initial treatment, he remains drowsy. The arterial blood gas (ABG) done 1 hour ago shows pH 7.28, pCO2 9.5 kPa. You are the Year 5 student, but you have been allowed to assess him before the registrar arrives. The current observations are shown. You need to take a focused history, examine him, interpret findings, and manage appropriately.
What this case teaches
Interpret the blood gas; target oxygen saturations of 88 to 92%; recognise the indications for non-invasive ventilation; set a ceiling of care conversation in motion.
How the case unfolds
- 1Focused HistoryHistory
- 2Focused ExaminationExamination
- 3InvestigationsInvestigations
- 4Working DiagnosisDiagnosis
- 5Immediate TreatmentTreatment
- 6Monitoring and Further ManagementMonitoring
The decisions available at each stage, and what each one costs or earns, appear when you run the case.
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A free account opens the simulator: the patient's observations move with your decisions, and every choice is scored and explained.
Taught in
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Educational content for students and clinicians in training. It does not replace professional judgement, local protocols or current prescribing information.