Overview
65 year old female with a history of cardiovascular disease, diabetes, and 30 pack year history of smoking is being admitted. She denied fever & chills, but described she developed a chronic cough with dyspnea. She was able to participate in her rehabilitation activities and was progressing as expected until two weeks ago. On the day of admission, the patient complained of worsening onset of dyspnea. She was found to be tachypneic and cyanotic with a respiratory rate of 38. Exam revealed crackles on the right and diminished breath sounds on the left. She was transferred to the closest hospital where she was emergently intubated.
The patient became hypotensive shortly after intubation and a continuous infusion of dopamine was started. A pulmonary angiogram was negative for pulmonary embolism (PAP 50/25 mm Hg) and an echo revealed normal LV and RV systolic function with no pericardial effusion. Mechanical ventilator settings for the first several hours of her hospitalization while on Volume A/C with a flow rate of 60 LPM were as follows:
Time | Rate | Tidal Volume | FIO2 | PEEP | Peak Pressure | Plateau Pressure | Mean Pressure |
|---|---|---|---|---|---|---|---|
15:33 | 22 | 500 | 1.0 | 0 | 26 | 24 | 18 |
16:16 | 24 | 500 | 1.0 | 0 | 29 | 26 | 22 |
17:30 | 34 | 500 | 1.0 | 0 | 32 | 28 | 24 |
20:28 | 38 | 500 | 1.0 | 0 | 39 | 32 | 27 |
Instructions:
- In what ways might you determine the cause of changes to the patient's lungs?
- How might you respond to these changes? Why?
- Outline protocols used at your facility or by physician groups, that might be used to treat this patient?
Please post your initial response by 23:59 EST THURS of Week 1, and comment on the posts of two classmates by 23:59 EST Sunday of Week 1.
Submission Instructions:
Each initial response must be at least 300 words, demonstrate course-related knowledge (integration of the course textbook), and include at least one peer-reviewed source. Please refer to the rubric below when constructing