Pulmonary Problem Solving III

Case One

Patient Chart
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.

Heart Rate:
Blood Pressure: /


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