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ARDS Escape Room
Tori Merrick
Created on February 10, 2024
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Transcript
An ICU upstairs is short staffed and you are next on the float pool list. Grab your bag and head up for report!
Nurse Report
Patient B
Patient A
89 yo Hx: pneumonia, COPD, recent RSV and FLU Chronic trach Admit 4 days ago for SOB and Rhonchi Neuro: A&O x1 Cardiac: SB with PVCs Resp: 40% 40L trach collar, 6.0 shiley uncuffed trach Urinary: foley good UOP GI: PEG, vital AF 1.2 @ 40/hr Vascular: tunneled CVC L subclavian Heme: no anticoagulation
32 yo Hx: alcoholism (sober 1yr) Admit 3/13 direct for liver transplant Neuro: A&O x3 Cardiac: NSR Resp: 8 ETT @ 24 @ lips, 40% peep 5 Urinary: foley poor UOP GI: NPO, NG to LIWS Vascular: RIJ MAC with DLIC Heme: heparin gtt not therapeutic
Next
Who do you see first?
Patient A
Patient B
Patient A has chronic respiratory problems, is trach collaring, and has not had recent acute interventions. Patient B is an acute transplant patient who is intubated and could have changes occur more rapidly.
Next
Considering patient A's medical history you are concerned for development of:
- Sepsis
- ARDS
- A PE causing stroke
- Increasing oxygen demands
Family called about patient A at 8am concerned about something called V/Q mismatch that the overnight resident kept going on about and how bad it is.
Next
You realize your patient may need to be reintubated if they are unable to continue protecting their airway. Discuss what you will need in the room and to gather later to intubate smoothly.
Next
The morning has gone smoothly so you take your leftovers to the breakroom for lunch
Next
Phew! Good work. Let's check on Patient A. She appears to be sleeping and breathing comfortably. You returnt to Patient B and draw the following ABG. pH 7.32, CO2 50, HCO3 24. Your provider wants to decrease the respiratory rate on the vent. WHY?
To make patient B more comfortable
Blow off more CO2
To make respiratory therapy happy
To increase oxygenation
The day is alomst done!
Next