lab case 183

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

  1. Describe and interpret the ABG
  2. What features in the patients history are concerning for increased morbidity and mortality from asthma? What are other high risk factors?
  3. Discuss ventilation settings of a intubated patient with asthma