To breathe, to breathe

 

This SAQ is worth 13 marks

A 33 year old woman is being managed in your ED with severe community acquired pneumonia. She is morbidly obese, with an estimated weight of 180kg and height of 160cm.

Her vital signs are:
GCS 15
Pulse 140 /min
BP 90/45 mmHg
RR 40 /min
O2 sats 90% 15L/min O2 via non-rebreather mask
Temp 38.5 degrees

The patient is becoming tired and you have assessed her as requiring intubation to maintain adequate oxygenation.

Question 1.
In the table below, list 4 difficulties that you may encounter during the peri-intubation period. For each difficulty, briefly describe how you will aim to minimise the problem. (8 marks)

Difficulty Solution                       

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 



Question 1.
Give the ventilator settings you would initially institute by completing the table. (5 marks)

Variable Setting        
FiO2                                                                 
Resp rate  
Tidal volume  
Positive end-expiratory pressure  
Peak pressure limit  



 

This SAQ is worth 13 marks

A 33 year old woman is being managed in your ED with severe community acquired pneumonia. She is morbidly obese, with an estimated weight of 180kg and height of 160cm.

Her vital signs are:
GCS 15
Pulse 140 /min
BP 90/45 mmHg
RR 40 /min
O2 sats 90% 15L/min O2 via non-rebreather mask
Temp 38.5 degrees

The patient is becoming tired and you have assessed her as requiring intubation to maintain adequate oxygenation.

Question 1.
In the table below, list 4 difficulties that you may encounter during the peri-intubation period. For each difficulty, briefly describe how you will aim to minimise the problem. (8 marks)

Difficulty Solution                       

Hypotension

  • optimise haemodynamics pre-intubation – IV fluid boluses N/S 1000mL
  • bolus metaraminol 0.5mg, aiming for systolic >90mmHg 

Hypoxia

  • optimise pre-oxygenation
  • high flow nasal prongs in addition to BVM with tight seal
  • bag pt though apnoeic period 

 

Difficult intubation
due to obesity
  • positioning – ramp position (head up), 1-2 pillows under head
  • have backup intubation equipment ready – bougie, LMAs,
    large laryngoscopes, short handle

difficulty ventilating pt

  • well sedated and paralysed once intubated
  • head up to unload diaphragm
  • airway adjuncts
  • ensure peak pressure limits
  • backup equipment
  • prepared for surgical airway if needed 

difficult BVM

  • use of airway adjuncts – Guedels, nasopharyngeal airways
  • optimise position


Question 1.
Give the ventilator settings you would initially institute by completing the table. (5 marks)

Variable                                       Setting                                         
FiO2 1.0
Resp rate 14 - 25 /min
Tidal volume 350 - 500 mL
Positive end-expiratory pressure 5 - 10 cmH2O
Peak pressure limit 35 - 40 cmH20

 

Total pass 10/13 corrects to 7.5/10 




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