June Case-Chasing Zebras

Catch the full episode on YouTube: https://youtu.be/tFxQiYzhEzQ?si=0DAQSbvsWG9o28aV

Special thanks to Emergency Medicine Specialists: 

https://ems-wi.com/

Transcript

0:00

my name is Matthew Treat, and I'm a physician assistant with Emergency Medicine Specialists. I'd like to introduce you to a short educational series called Chasing Zebras. In this series, we will feature the cases you submitted to the educational committee. Thank you to Dr. What's up? This is Dr. Ford, ER provider with EMS, as well as host of the podcast Pulse Check Wisconsin. And this is the official takeover of the amazing educational series, Chasing Zebras, brought to you originally by Matt Treat. Today, we're going to bring you a case by one of our awesome colleagues, Dr. Laurie Benson. And with that being said, let's go ahead and get into it. Patient has a 22 year old female with a past medical history of asthma. Who's presenting with complaints of worsening asthma symptoms over the last 24 hours. The patient arrives, combative altered as well. EMS has attempted to give her a C-PAP of which she removed. They also gave her a Subcutaneous Epinephrine and dexamethasone,Duo Neb and magnesium prior to arrival. They're unsure how much medication she received because the infiltrated on arrival. Patient's past records demonstrate that she is prescribed. an albuterol inhaler. Was she states that she's been using all day. Patient states that she ran out of the albuterol inhaler and was using an old inhaler. Father and the patient's friend states that the patient just got a new cat. During her course, the patient was given multiple doses of continuous albuterol. The time of arrival. She was given magnesium and additional Solu-Medrol. The patient was placed on bi-pap by. The provider. Unfortunately, however, the patient continued to be combative. The decision was made to ultimately intubate the patient for respiratory and airway security. After the patient was intubated. The decision was made to bag the patient as the patient's breath sounds were still very tight. Patient's chest x-ray was clear. With no evidence of pneumomediastinum pneumothorax. The patient's blood gas reveals evidence of a respiratory acidosis with a very high PCO, two. As noted. The patient was decidedly admitted to the ICU. Throughout the day, the patient develop worsening hypercapnia and worsening auto peep, which required her to be taken off of the ventilator often. Patient was started on empiric antibiotics and bronchoscopy was performed. The patient did not demonstrate any signs of any large mucus plugging. However, due to her lack of improvement and difficulty with ventilation. Again, the patient had to be taken off of the vent often To decompress the lungs. The patient was transferred to. FML H to place her on VV ECMO.

Speaker: 3:23

Which allow for respiratory and circulatory support and gas exchange to occur outside the body.

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So this case was a key example of both the ER provider, as well as the ICU providers doing the best that they can and taking the next step to elevate the patient's level of care. When needed. This should be the case for adult and pediatric patients. Remember that there are algorithm's available to you for asthma management. And as a reminder, so that's it. So the key in this is All asthma is not typical asthma. If you feel like you need to escalate to the next level of care, feel free to do that. Push that button again. If you need any information on pediatric asthma, check out the algorithms. If you need a copy, feel free to email me should be available in all your emails. It should be available at all the hospitals that we provide care to as well. So with that being said. Thank you to the Educational Committee. Thank you, Dr. Benson. Thank you, Matt Treat, and I'll see you guys on shift Peace.