17 year old female known asthmatic presents with a 24 hour of an exacerbation of her asthma. She has finished 2 salbutamol MDI’s over the last day and started on oral steroids.
She has received 2 nebs with the ambulance. The patient has had 1 previous ICU admission as a child. O/E BP 110/80 HR 120 Sats 90% FIO2 0.4 Temp 37.2 RR 35. She is talking words only, using accessory muscles, and has good air entry with a wide spread wheeze. GCS 15
ABG on FiO2 0.4
pH7.55 Na 138 mmol/l
pCO2 17mmHG K 3.5mmol/l
pO2 75mmHG Cl 107mmol/l
HCO3 14 mmol/l Cr 64 umol/l
B/E -6 Glucose 7.4 mmo/l
Lactate 2.5 mmol/l
- Describe and interpret the ABG
- What features in the patients history are concerning for increased morbidity and mortality from asthma? What are other high risk factors?
- Discuss ventilation settings of a intubated patient with asthma