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🚨🚨🚨🚨another edition of #fromthetrenches🚨🚨🚨🚨
Recent case of mine —> clinical details altered for anonymity
59 year old male presents to ED with SOB. Family states was at home at fell in bathroom. Hx of HTN/DM. Unsure of meds or compliance to therapy. Arrival BP 79/42 😱😱
Recent case of mine —> clinical details altered for anonymity
59 year old male presents to ED with SOB. Family states was at home at fell in bathroom. Hx of HTN/DM. Unsure of meds or compliance to therapy. Arrival BP 79/42 😱😱
Patient was given IVF bolus but this worsened SOB—>started on Bipap—>intubation. Post tube pulse ox 77% on 100% and 10 PEEP 😫
Post tube CXR—->very convincing pulm edema
MICU called to help with oxygenation . Some concern for cardiac event but too hypoxic for Lab
Post tube CXR—->very convincing pulm edema
MICU called to help with oxygenation . Some concern for cardiac event but too hypoxic for Lab
I go and immediately walk PEEP up to 20.
Plat/driving pressures all improve with PEEP titration. Sats go from 77–>92. I’m happy.
Diurese, get some labs, little levo, +/- cath depending on what happens, and I’ll be back to the call room in no time.
Plat/driving pressures all improve with PEEP titration. Sats go from 77–>92. I’m happy.
Diurese, get some labs, little levo, +/- cath depending on what happens, and I’ll be back to the call room in no time.
