!!!acute desaturation!!! Flashcards
68 year old lady who has been admitted with an infective exacerbation of her COPD.
Mrs Khan has a past medical history that includes type 2 diabetes, coronary artery disease and has suffered two myocardial infarctions in the past.
She has hypothyroidism and was previously treated for breast cancer.
Since her admission two hours ago she has been started on nebulisers, IV fluids and IV antibiotics. The nurse has contacted you as the patient has acutely desaturated and is struggling to breathe. The nurse sounds concerned on the phone.
ou are on the phone with the AMU Nurse. What information would you want to know over the phone?
DOES SHE THINK THE PATIENT IS ABOUT OT HAVE A CARDIAC ARREST OR PERI ARREST IF SO PUT OUT A CRASH CALL IN 2222
i would alos like to know there current observation
Is the airway patent , CAN THE PATNET TALK
DO THEY SOUND WHEEZY or have STRIDOR
such as the HR , BP , SATURATIONS , THE TEMPRATURE , AVPU
how they presented to AE
the treatment we have given so far - is this a chronic or acute deterioration
any drug allergies that we know of
patient has penicillin allergy what would you do ?
PATINET HAD ANAPHYLATIC REACTION
. Inform the nurse to put out a 2222 call immediately.
administer 0.5mg of adrenaline if they are not competent ask them o prepare it for me
to stop the antibiotics and to continue fluids
PATINET SHOULD BE ON HIGH FLOW OXYGEN !!!!
ADVICE TO START CPR IF THEY GO TO CARDIAC ARREST
You review the patient quickly and decide that she is having an anaphylactic reaction. What would you do?
CHECK FOR LIFE THREATENING FEATURES
airway - swelling , hoarseness or stridor
breathing - rapid , tiring , cyanosis , saturation below 92 percent
WHEEZY
circulation : pale clammy , low blood pressure fainting
if there is no response to the first IM adrenaline after 5 mins of the same dose I WOULD ADMINISTER THE SCEOND ONE
You initiate the treatment with IM Adrenaline. Unfortunately, Mrs Khan continues to deteriorate and collapses. You assess for a pulse and cannot find one.
i would shout for help
i would follow the ALS protocol
I would start cpr and ask the nurse to bring the crash trolley , I would ask on of the nurses to put the defibrillates pads on and turn on the defibrillates
ensure the nurses have called for help and put our an arrest call
once crash team has arrived i would ask someone to carry on the CPR and handover the case to the lead
How do we learn from events such as this?
THIS IS A SERIOUS INIDENT
SERIOUS INCIDENTS GETS DATIXED
so there can be an investigation and look at way that it can be avoided
when breaking bad news important things ?
Make sure you finish by saying you will personally take him to see his wife on ITU.
Tell the husband that if he would like to speak to your registrar or consultant you can arrange this.
what is duty of candour ?
being open and honest if something has gone wrong
apologising
explaining to the patient of the possible short term and long term effects
and then look for ways to resolve this if there is any
