A 50 year old female presents to ED complaining of shortness of breath, an increase in her Ventolin use (12 puffs every 30 min overnight). She has been unwell with ILI symptoms for a week and started a course of steroids 5 days ago. The patient has a background of poorly controlled asthma, with 1 ICU admission 16 years ago that required prolonged ventilation.

The patient is talking single words only and tripoding. Below is her initial VBG

pH 7.35                               Na 140mmol/l

PCO2 45 mmHg                K 3.2mmol/l

PaO2 35mmHg                  Cl 105 mmol/l

HCO3 18mmol/l                 Cr 85 umol/l

B/E -4                                  BSL 6.5 mmol/l

Lactate 4

Describe and interpret the VBG

Discuss a stepwise approach to management of this patient