Acute respiratory failure (what would you do)
Medgeeks with Andrew Reid
Medgeeks
4.8 • 997 Ratings
🗓️ 7 June 2018
⏱️ 18 minutes
🧾️ Download transcript
Summary
A 65 year old female presents to your ER with difficulty breathing over the past 3 days, despite increasing her home oxygen tank to 3 liters. Her husband called 9-11 because she wasn't really acting herself.
EMS arrived and found her sats in the 70s and put her on a non-rebreather mask and had an improvement in her sats to the low 90s.
They also reported some wheezing on exam, so they gave her one duoneb prior to arrival.
Per EMS she has a past medical history of COPD (on 3 liters around the clock), CHF with an EF of 40%, hypertension, hyperlipidemia, and type II DM.
So, you walk into the hospital room and the first thing you notice is that the patient appears to be in respiratory distress. Shes' wearing a nasal canula which is set to 5 liters. She's breathing fast (belly breathing), her sternocleidomastoids are going to town, she has accessory muscle use.
Her sats are at 82% with good wave form on the monitor. Heart rate is in the 80s. Systolic BP of 150. She's able to tell you her name and her story - but she's definitely having difficulty speaking due to the respiratory distress.
You listen to her lungs and she's wheezing, but also hear some crackles at the base.
What would you do?
Today, we'll show you what to do next, so you don't freeze up should this patient ever walk into your hospital...
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Transcript
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| 0:00.0 | Team, what's going on? Yes, a new voice to the med geeks podcast. You're right. My name is |
| 0:06.4 | Zach Lavender and I'm a new member to the med geeks crew. I work full time as a PA in |
| 0:10.9 | pulmonary critical care and also work work part-time in urgent care. |
| 0:15.5 | On the side I also work as a clinical assistant professor at Cornipiac University. |
| 0:21.2 | Figured this wasn't enough so what the heck I joined med geeks. |
| 0:24.0 | No let me tell you I'm really excited about joining the team and I really look forward to sharing my clinical experiences with you. |
| 0:31.0 | My biggest request though of you guys is please give your feedback. What you liked, |
| 0:36.2 | what you didn't like, it really is only going to make these podcasts better. So enough with |
| 0:40.6 | the introduction, let's get to the good stuff. I promise in the future there won't be any of this intro baloney. |
| 0:46.6 | So without further ado, today I want to discuss approaching the acute respiratory failure patient. |
| 0:53.6 | And I want to give you a few clinical pearls |
| 0:55.6 | to put in your pocket when approaching a patient |
| 0:58.1 | who has difficulty breathing. |
| 1:00.2 | So a 65-year-old female presents to your ER as a medical alert with difficulty breathing over the past three days, |
| 1:07.0 | despite increasing her home oxygen tank to six liters. |
| 1:11.0 | Her husband called 911 because she wasn't really acting herself. |
| 1:14.7 | EMS arrived, found her sat in the 70s, so put her on an on-rebrather mask, with improvement in |
| 1:20.8 | her sets to low 90s. They also reported some wheezing on exams so they gave her one duodneb prior to arrival. |
| 1:28.4 | Per EMS, she has a past medical history of COPD on 3 leaders around the clock, heart failure reduced |
| 1:35.2 | the F of 40%, hypertension, hyperlipidemia and type 2 diabetes and this was all from |
| 1:41.1 | interview with the husband while en route to the hospital. |
| 1:44.0 | So you walk into the patient's room and the first thing you notice is that the patient appears to be in some |
... |
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