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Case Study:

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is self-ventilating on air. She is also attached to a cardiac monitor on transfer which shows:

  • Heart rate: 115 beats per minute
  • Last BP: 95/50 mmHg
  • SpO2: 94%
  • Respiratory rate: 24 breaths per minute

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

Feeling unwell for last 3 days, started on oral antibiotics by GP for a possible Urinary Tract Infection (UTI) but has been feeling worse.

is a smoker and uses inhalers.

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

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

was admitted to the department at 17:50. She required 500 mL of Hartman's stat and is currently having a second fluid bolus of 500 mL. This is running over 4 hours through a pink cannula sited in her left wrist.

Chest x-ray and arterial blood gas (ABG) undertaken in ED.

Urinalysis undertaken; nothing abnormal detected (NAD).

Sputum specimen sent to labs for analysis.

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

Temp 38.4°C - blood cultures have been taken. Tazocin is given. Nebulisers salbutamol and atrovent administered for a slight wheeze with good effect.

is aware of what is happening and was 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 mmol/L
Lactate 1.8 mmol/L
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