ARDS Escape Room

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 A

Patient B

89 yo Hx: pneumonia, COPD, recent RSV and FLUChronic trachAdmit 4 days ago for SOB and Rhonchi Neuro: A&O x1Cardiac: SB with PVCsResp: 40% 40L trach collar, 6.0 shiley uncuffed trachUrinary: foley good UOPGI: PEG, vital AF 1.2 @ 40/hrVascular: tunneled CVC L subclavianHeme: no anticoagulation

32 yoHx: alcoholism (sober 1yr)Admit 3/13 direct for liver transplantNeuro: A&O x3Cardiac: NSRResp: 8 ETT @ 24 @ lips, 40% peep 5Urinary: foley poor UOPGI: NPO, NG to LIWSVascular: 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:

1. Sepsis
2. ARDS
3. A PE causing stroke
4. 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

To increase oxygenation

Blow off more CO2

To make respiratory therapy happy

The day is alomst done!

Next

The team gets a vent in the room to begin correcting Patient A's hypercarbic rspiratory failure and all is well. Time to give report and go home!