A 72 year old female is experiencing respiratory distress. Her initial ETCO2 was 46 mmHg and now has increased to 60 mmHg. What should you do?

In this scenario, the primary concern is the patient’s increasing ETCO2 level, which signifies that she is retaining carbon dioxide, likely due to inadequate ventilation. Assisting her breathing with a bag-mask device is an appropriate response because it directly addresses her inability to ventilate effectively. By using a bag-mask, you can support her respiratory efforts, help to reduce the elevated CO2 levels, and improve her oxygenation until further interventions can be planned or until she stabilizes.

Choosing to assist her breathing will likely result in a more immediate improvement in her respiratory status compared to simply administering oxygen, which does not aid in ventilation. While bronchodilators may provide some relief if bronchospasm is a factor, they would not effectively address the acute respiratory distress and hypercapnia indicated by the rising ETCO2. Immediate intubation, while sometimes necessary in severe cases, is invasive and typically reserved for patients who are unable to protect their airway or have severely impaired ventilation that cannot be corrected through less invasive means.

Therefore, assisting her breathing with a bag-mask device is a timely and effective intervention for managing her respiratory distress and improving her CO2 clearance.