Intubating the asthmatic
Medgeeks with Andrew Reid
Medgeeks
4.8 • 997 Ratings
🗓️ 20 September 2018
⏱️ 11 minutes
🧾️ Download transcript
Summary
You're asked to see a 22 year old female with a past medical history of asthma who presents to the emergency room with increasing shortness of breath, chest tightness, and wheezing.
Over the past 24 hours she's been non-responsive to her home nebulizer treatment every 4 hours.
A quick chart review allows you to see the patient has required ICU admission and mechanical ventilation last year due to an asthma exacerbation.
As you walk into the room, you notice the patient can only speak one word at a time before taking deep breaths. She's in respiratory distress with an O2 sat of 88% on 2L NC.
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Transcript
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| 0:16.3 | Team how we doing zak here from med geeks so you start your shift you're asked to see a 22 year old female with a past medical history of asthma who presents to the emergency room with increasing shortness of breath, chest tightness, and wheezing over the past 24 hours non-responsive to her home nebulizer treatments every four hours. On quick chart review, you see the patient as required |
| 0:25.5 | ICU admission and mechanical ventilation last year for asthma exacerbation. |
| 0:29.7 | As you walk into the room, you notice a handful of bad signs immediately. |
| 0:35.0 | You introduce yourself and the patient says hello and introduces herself, however, can only say one word at a time due to respiratory distress. |
| 0:44.8 | The patient's sitting on the edge of the stretcher. |
| 0:47.2 | She has sweat coming off her forehead. |
| 0:49.1 | She's tachypnic, roughly 30 breaths per minute, and she's using her sternoclyto mastoid muscles to support her breathing |
| 0:56.0 | and her oxygen saturation are 88% on 2 liters nasal cannula. |
| 1:01.0 | You first increase the oxygen flow rate to 4 liters with improvement in |
| 1:05.1 | or saturation to 90%. You quickly listen to her lung sounds and you hear |
| 1:09.9 | minimal amount of wheezing bilaterally. |
| 1:13.6 | Clearly, your patient is unable to provide a focus history given the respiratory distress, |
| 1:18.4 | but luckily mom is at the bedside. |
| 1:20.7 | She quickly tells you that her daughter's shortness of breath, chest tightness and wheezing |
| 1:24.8 | started over the past 24 hours and didn't improve the home nebulizer treatment. |
| 1:29.5 | She was admitted to the ICU last year requiring intubation and heavy doses of steroids. |
| 1:35.0 | She was also seen last month for a mild asthma exacerbation at an urgent care and required an oral steroid taper. |
| 1:45.0 | At that time she was diagnosed with a common cold which triggered her asthma symptoms |
| 1:50.0 | following the steroid taper, her asthma symptoms improved for about three weeks until now. |
| 1:55.0 | She denies any other symptoms including fever, productive cough, headache, nasal congestion, |
| 2:01.0 | rhinorrhea, sin congestion sore throat rash no nausea |
| 2:05.8 | vomiting or diarrhea and no abdominal pain it was just that shortness of breath |
... |
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