Learning Objectives

• ABCDE assessment in critically unwell patient
• Blood gas interpretation
• Respiratory failure types
• Recognising delirium
• CURB-65 score
• Sepsis management
• Case escalation

Background

• Elderly patient presenting with hypomanic delirium
• Type I respiratory failure secondary to CAP
• Sepsis
• Initial assessment in cubicle
• Interpretation of investigations: ABG / bloods / ECG / CXR
• Escalation and transfer to Resus

Case

Patient brought by paramedics

68-year-old female: Brenda

Husband is present in cubicle

PC: 4-day history of cough and SOB.

HPC: Non-productive cough for last 4 days.

Becoming progressively SOB over last 2 days, and now struggling to breathe.

Associated right sided pleuritic chest pain mostly on coughing.

Today, husband is concerned as Brenda seemed confused.

No rashes, no headache, no abdominal pain and no urinary symptoms.

PMH: Hypertension / Hyperlipidaemia / Osteoarthritis

DH: NKDA

Lisinopril / Simvastatin / Paracetamol

SH: Retired teacher / ex-smoker / independent / lives with husband

Observation & Examination

Brenda looks flushed and sleepy.

GCS 13 (E3V4M6) T 36.8°C CRT 2 secs

BP 90/54 HR 123 RR 26

SpO2 88% on RA

HS I + II + nil

Chest right basal crackles and decreased air entry

Abdomen soft / non tender