Too breathless to finish a sentence

A 68-year-old with severe COPD arrives grey and drowsy after three days of a chest cold getting the better of him.

68-year-old manED, resus bay 3Fictitious educational patient

Severe COPD (FEV1 34% predicted)Chronic CO2 retention documented in clinic lettersEx-smoker, 60 pack-years

Day 0 · 07:50

Arrival

Three days of increasing breathlessness and green sputum after a cold. This morning his wife found him confused. The paramedics, worried by a saturation of 74%, have him on high-flow oxygen via a non-rebreathe mask; he is now drowsy, saturating 97%.

Vitals

HR108BP142/84RR12SpO297% (15 L NRB)T37.4

Examination

Chest: Poor air entry throughout, prolonged expiration, scattered wheeze; using accessory muscles less than expected for the story.
Neuro: Drowsy, rousable, flapping tremor of the outstretched hands.

Saturating 97%, and MORE drowsy than when the paramedics found him. What is the first correction?

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