I'm an ICU nurse that recently had a pt in COPD Exacerbation. Ms "X" was rapid responded from a med/surg floor the day before. She was on BiPAP: FiO2 40%, IPAP-18, EPAP-8. O2 sats maintaining 88-93% all night.... Pt drowsy but able to follow simple commands. Her ABG showed CO2 at 98 twelve hours prior to my shift. She also was a DNI. About 10 hours into my shift she was really starting to poop out...(becoming lethargic, accessory muscles being used, tachypneic, etc...). I had a stat ABG drawn and the highest CO2 level our machine reads is 110... Her CO2 was beyond that bc it wouldn't register. I called the MD and long story short.... Without intubation, the DR told us to manually bag her to try to blow off excess CO2..... I call the RT and another RN to come assist while I gave the unfortunate news to the one family member staying with her. I explained that she was very critical and on the verge of coding and the rest of the family should get here asap. Her sat's were now in the 70s, she was guppy breathing and her HR was beginning to drop. We had to do something stat. Me and my charge nurse bagged this woman for over 45 minutes just to keep her alive long enough for her kids to arrive.... Even through the arms, hands and back were cramping- it was worth giving her family the extra time to grieve and say goodbye. This is just one reason why this is not just a job, its MY PASSION!