Patient is a 46-year-old male with no known past medical history who presented to the emergency room with a two day history of fever and productive cough with rust colored sputum. At time of arrival, BP 130/87 HR 96 RR 22 unlabored SPO2 95% RA.
Chest x-ray showed a right middle lobe infiltrate.
ABG on room air: pH 7.32, PCO2 32, PO2 78, HCO3 – 18.
He was started on antibiotics and admitted to the floor. Four hours later, the nurse reports that his BP is 85/60, HR 120 beats/minute, RR 34 and labored and his oxygen saturation, which had been 97% on 2L oxygen by nasal cannula, is now 78% on a nonrebreather mask. He is diaphoretic, less responsive, unable to speak in full sentences, and he is using accessory muscles to breathe. Lungs reveal diffuse crackles bilaterally. Repeat chest x-ray shows increasing bilateral, diffuse lung opacities.
Repeat ABG on the non-rebreather: pH 7.17, PCO2 45, PO2 58, HCO3-14.
In a minimum of two full pages, excluding title and reference pages, address the following:
- Describe your initial approach to the patient, including, labs, plan, and list any additional information you would like to know.
- The decision is made to intubate the patient. Intubation is successful and the endotracheal tube has been verified and secured.
- What are the five most common elements needed for ventilator initiation?
- Explain the difference between AC, Synchronized Intermittent Mandatory Ventilation (SIMV), Pressure Regulated Volume Control (PRVC) and Pressure Control (PC).
- Explain how to determine the appropriate tidal volume, respiratory rate, FiO2 and PEEP for this patient.
- Provide a complete set of ventilator orders for this patient.
Be sure to include an abbreviated version of the case (in your own words) in the introduction of your journal. Based on the above case study, address each section of the Journal rubric (found in the Grading Rubrics section under Course Resources) and use it to guide your completion.
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