The Real-World Boards: Question #17
Intubating a 54-year-old woman with respiratory failure and a borderline pre-induction BP
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You arrive at the bedside of a 54-year-old woman in acute respiratory failure after being called by the lead nurse on your hospital’s rapid response team. “Pneumonia, heart failure, renal failure, DKA,” he reads off the EMR screen. “Came in this morning on 5 liters and got ceftriaxone and Lasix, but just got worse.” An ABG 4 hours earlier showed pH 7.31, pCO2 45, paO2 58 on nasal cannula oxygen.
She is now receiving noninvasive ventilation with FiO2 100% with SpO2 of 85%, labored breathing, and increasing agitation.
Blood pressure is 98/66 and pulse is 110. Chest film shows bilateral infiltrates and a moderate-sized pleural effusion.
You advise the team to set up for immediate intubation.
The lead nurse grips his oversized energy drink more tightly. “I think she’s gonna crash,” he says.
