All info accessed through Australian College of Nursing. Principles of Acute Care Nursing
Case Studies Case study: Bill Bill, a 40â€yearâ€old, has had asthma since childhood. He has experienced many hospitalisations and required longâ€term oral steroids. He presents to the emergency department (ED) with acute exacerbation of his asthma that he believes has been triggered by a known allergen. At home he increased his salbutamol with little effect. He is now anxious and agitated. On presentation to the ED his clinical assessment reveals: Noted use of accessory muscles RR 36 breaths/minute HR 150 beats/minute BP 142/88 mmHg Temperature 36.2oC SpO2 88% Height 170 cm Weight 80 kg Management in the ED includes: Oxygen via a nonâ€rebreather mask at 15 L/min Salbutamol, ipratropium bromide via nebuliser First ABG Suggested normal values pH 7.25 7.35â€7.45 PaO2 60mmHg 80â€100mmHg PaCO2 55mmHg 35â€45mmHg â€ HCO3 22mmol/L 22â€26mmol/L Base excess â€2 â€2 to +2 No improvement so further management of: IV hydrocortisone Adrenaline via a nebuliser Salbutamol as an intravenous infusion IV normal saline at 100 mL/hour Arterial blood gas analysis
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