Home > Acute medicine, Critical Care > Term 5 Week 10 (w/c 25/3/13)

Term 5 Week 10 (w/c 25/3/13)

Welcome to the last week of term before the Easter Break.

This week @Gasclass has been called to the Emergency Assessment Unit to a 32 year old man who was admitted with acute shortness of breath. He is known to have asthma and has had multiple hospital admissions over the last 6 months.

As you head to the ward to see him, what are your intitial thoughts?

You arrive on the ward to see a distressed man. He is sitting upright in bed using his accessory muscles to breath and has a RR of 45  He has a nebuliser driven by O2 in progress. Oxygen saturations are 93%. He has been given iv steroids and antibiotics.

A CXR has been performed but is not yet avaliable, Breath sounds are very quiet.

What are your thoughts? What do you do next?

The CXR shows no pneumothorax.  There has been no response to repeated nebulisers or the Magnesium Infusion. You decide that you need to intubate and ventilate the man as as his conscious level is dropping  and his pCO2 is rising.

What is your plan for intubation?

You successfully intubate the patient and transfer him to ICU.

What is your ICU plan of management?

More information later.

There are no trick questions in #Gasclass. Everyone’s contribution is welcome. Please do not forget to add the ‘hashtag’ #gasclass to every Tweet so that it is included in the conversation. To help give new contributors an opportunity to join in we would advise that you should only add one idea per tweet and not contribute until another Tweeter has joined in.

@Gasclass

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