"improving intensive care in Scotland"

Ventilation short test

This test will be forwarded to your supervisor only if he/she has contacted the training and education group.

A 56-year-old hypertensive smoker is admitted with a 4 day history of breathlessness, chest pain, cough, dirty sputum and general malaise. He has had no previous hospital admissions.  His medications are ramipril, atenolol and salbutamol inhaler.  He weighs 75kg.

He is talking in short sentences, but is confused and has a respiratory rate of 30 breaths/minute. His SpO2 is 85% on 6 l/minute O2. He has left basal crackles. His BP is 104/45mmHg, HR 120 beats/min, sinus tachycardia. His capillary refill time is 4 seconds.

Investigation results

Na 141, K 4.8, Cl 110, Urea 14.6, Creat 145

Hb 14.8, WCC 16, platelets 156

His CXR shows left basal infiltrates.

PaO2 6.8kPa, PaCO2 6.9, HCO3 26, H+54

1. His oxygen therapy should *



2. Oxygen therapy is likely to *



3. He is transferred to the medical HDU. His condition deteriorates. His respiratory rate is now 35 /min, PO2 6.0, PCO2 8.6, HCO3 16, H+ 75 on high flow oxygen. He cannot complete sentences. There is noticeable accessory muscle use. MAP 65 mmHg, HR 120 /min NSR. He is drowsy. You should *




4. At some point, you safetly intubate and ventilate the patient. Your consultant drops dead! and you have to choose ventilator settings. Reasonable initial settings are (tick as many correct choices as you want) *






5. About 3 days later, you are in ICU and the same patient's gas exchange deteriorates over a four hour period. Ventilatory settings: SIMV, FiO2 0.6, RR 15, I:E ratio 1:2, Vt 600ml, PEEP 8cm H2O Blood gases are: H+ 55, PO2 7.5 KPa, PCO2 8.9 KPa, HCO3 18 Sensible measures in this situation would be (tick as many correct choices as you want) *







This module met my expectations *




Your level of training *










 

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