You are on your critical care rotation helping take care of multiple ventilated patients. At the end of your night shift, one of the respiratory therapists comes up to you and says, “Hey, the new ABG just came back. It is 7.25/52/70/24 .” What do these numbers mean and what can you do to help?
A 47-year-old man with COVID-19 pneumonia complicated by severe acute respiratory distress syndrome (ARDS) suddenly desaturates. Point-of-care ultrasound and chest x-ray are consistent with pneumothorax. After placement of a pigtail catheter, hypoxemia persists and a large continuous air leak is present. What are the next steps in management of a suspected bronchopleural fistula?
Remember to look at the differential of your CBCs. A recent publication demonstrated in retrospective data that higher proportions of bands on the WBC differential were associated with increased likelihoods of both severe bloodstream infections and mortality.
You’re working in the ICU overnight and are having difficulty obtaining a blood pressure for a patient that was just transferred to your facility for septic shock secondary to pneumonia. You make the decision to place an arterial line. You place the line sterilely using seldinger technique and connect it to the monitor. Your hard work paid off and you are rewarded with a waveform.
Less than 5 percent of patients hospitalized for acute asthma exacerbation will require mechanical ventilatory support. However, ventilator management in status asthmaticus is unique and the impact of increased airway resistance on ventilation strategies must be understood to avoid life-threatening complications like severe acidosis, barotrauma and hypotension.