SAQ 572 – Pre-hospital / Retrieval – septic respiratory failure before fixed-wing transfer

Review Completed

Marked out of 10.00

A 69-year-old morbidly obese man presents to a rural emergency department with 2 days of worsening dyspnoea. He has been treated for respiratory sepsis with 3 L normal saline plus IV ceftriaxone and azithromycin according to local guidelines. The local doctor requests retrieval to a tertiary hospital because there is no HDU facility and asks how to optimise him while waiting for the retrieval team.

Parameter	Result
Initial HR	124/min
Initial BP	90/54 mmHg
Initial RR	36/min
Initial SpO2	90% on 8 L/min Hudson mask
Initial temperature	38.8 C
ABG pH	7.10
PaO2	59 mmHg
SaO2	91%
PaCO2	60 mmHg
HCO3	16 mmol/L
Base excess	-9
Lactate	6 mmol/L
Current HR	119/min
Current BP	89/47 mmHg
Current RR	38/min
Current SpO2	91% on 15 L non-rebreather mask

What is the acid-base abnormality?

(Marked out of 1.0)

/ 1

List three (3) key management steps you would recommend during the anticipated 2 hours before retrieval-team arrival.

(Marked out of 3.0)

/ 3

When the retrieval registrar arrives, the patient is still on a non-rebreather mask and ABG results are similar. He is cooperative but finds the mask uncomfortable, and fixed-wing transfer will take 2 hours including transfers. Complete the table of relative risks and benefits for respiratory support options.

(Marked out of 6.0)
</p> <table class="saq-prop-table"> <thead> <tr> <th>Respiratory support</th> <th>Risk</th> <th>Benefit</th> </tr> </thead> <tbody> <tr> <td>Non-rebreather mask (NRM)</td> <td></td> <td></td> </tr> <tr> <td>Non-invasive ventilation (NIV)</td> <td></td> <td></td> </tr> <tr> <td>Intubation and ventilation (IPPV)</td> <td></td> <td></td> </tr> </tbody> </table> <p>

/ 6

Total Score: 0 / 10

Percentage: 0%

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