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Critical Illness Case Summary Write Up
Critical Illness Case Summary Write Up
Critical Illness Case Summary Write Up
Examination:
Airway: Clear with no respiratory effort. Adjunct (i-gel) was inserted with
BVM to maintain airway and ventilation.
Breathing: RR via BVM: 10-12/minute (no respiratory effort by patient).
Ausc: crackles heard in lung bases, SaO2: UTR (95% on ABG @ 100% O2)
Circulation: HR: 115, HS1+2+0, BP 112/80mmHg, cool peripheries, CRT
>5s
Disability: GCS: 3/15, Pupils: fixed and dilated 5mm bilaterally. Temp:
36.6, BM: 6.1
Exposure: Abdomen soft + non-tender.
Investigations:
Oxygen saturations were measured to ensure that the patient was
ventilating adequately. An ABG sample was taken to give a more precise
measure of blood gases mainly O2 and CO2 levels as well measuring
glucose and lactate to ensure adequate tissue perfusion and reverse any
underlying pathology.
ABG results:
pH 7.025
PCO2 17.85
HCO3 34.2mmol/L
Lactate 13.1mmol/L
- Once the patient had been admitted to hospital, the DNAR was
discussed in further detail and all teams were in agreement that
further intervention would not be appropriate. DNAR form was
completed -> i-gel removed -> patient made comfortable with
presence of family -> end of life care
Cardiac arrest mortality following CPR. In the UK, fewer than 10% of
all people in whom a CPR attempt is made outside hospital survive.
This is possible where the arrest is recognised immediately,
bystanders perform CPR, and an automated defibrillator is used
before the ambulance service arrive. Survival rates in excess of 50%
have been reported under these circumstances. (Resuscitation
Council, 2016)
Is there anything that could have been done better for this
patient?
In retrospect, I wondered if a DNAR discussion with family/patient should
have been made at an earlier date. This may prevent unnecessary
distress to the patient/relatives. However, I do appreciate the difficult
nature of these conversations and of course timing is crucial.