CASE STUDY:

arrives on the Medical High Dependency Unit (MHDU) with a registered nurse from the Emergency Department (ED) at 20:00.

Handover from Emergency Department

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is attached to 15 L of oxygen via a re-breath mask. She is also on a cardiac monitor which shows:

Heart Rate 115 bpm
Last BP 85/40 mmHg
SpO2 99%
Respiratory Rate 24 bpm

The nurse states that was found collapsed at home at 17:00 by her daughter, Alice, who was dropping off her mother's shopping.

manages independently around the house but struggles to do activities like food shopping.

is a smoker and uses inhalers.

She has arthritis in her knees which limits the distance she can walk and is on regular analgesia.

was admitted to the department at 17:50.

She has had 1 litre of Hartmans stat and is on her second bag which is running through over an hour via a pink cannula in her left wrist.

She has a green venflon in her right cubica fossa which does not appear to be working very well.

Her systolic has increased and she is not as tachycardic now.

Temp 38.4°C - blood cultures have been taken and tazocin given. ED nurse realises gentamicin has also been prescribed at 19:30 but has not yet been given.

Nebulisers salbutamol and atrovent administered. Bloods and an ABG have been taken.

is now responding to voice and has been incontinent once when she first arrived in ED.

Blood Gas Result

Arterial Sample
Time: 18:30

pH 7.2
pCO2 3.5 kPa
pO2 10 kPa
HCO3 16 mmols/L
Lactate 4.1 mmols/L
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