You are called to a nursing home to see 75 year old Mavis, who is complaining of shortness of breath.

On arrival

On arrival you are met by nursing staff, who take you to Mavis’s room.

They advise that she has had a sudden onset of DIB and confusion approximately an hour ago.

Sp02

They did not call straight away, as they thought they could treat her themselves.

The nurse states she had a SpO2 of 78% and they are advised to keep it between 88-92%, so they gave her oxygen.

Notes

On arrival at Mavis’s room, you find her slumped in the chair with a high flow mask on.

You are handed her notes, there is a large label on the front that states ‘Hypercapnic respiratory failure risk’.

History

The notes show that she is new to the nursing home, having only arrived last week. She has a history of COPD, AF and hypertension.

She has been well recently.

Observations

Her observations are:

Respiration rate 30

SpO2 98%

Currently on Oxygen

Blood pressure 155/85

Pulse 119

Consciousness level C (confused)

Temp 36.2

You are called to 28 year old James, who is complaining of shortness of breath. On arrival you are met by James’s partner, who takes you to the kitchen of their first floor apartment. They advise that over the last three hours James has become increasingly breathless.

Nebuliser

They did not call straight away as they thought they could treat him themselves with his asthma inhaler. This has been ineffective and his breathing has become more difficult he feels he needs a nebuliser.

Sp02

James is unable to complete full sentences. James observations reveal SpO2 of 93%.

Wheeze

James is sitting in a tripod position and you can hear an audible wheeze.

Additional History

James’s partner gives you some additional history that James has asthma which he manages well with his inhaler but on rarer occasions he has had to have a nebuliser and attend the ED.

PEF

His PEF was recorded at 380 he tells you he would usually achieve 620 l/min

Observations

His observations are:

Respiration rate 28

SpO2 93%

Not on Oxygen: Air

Blood pressure 125/70

Pulse 112

Consciousness level A

Temp 36.2

You are called to a 19 year old male stabbed to the right side of the chest.

You find your patient leaning up against the wall with police on scene providing aid.

The patient appears a good colour and is able to give you a history. There is an obvious isolated stab wound to the chest with no active bleeding.

First Aid

You find your patient leaning up against the wall with police on scene providing aid.

History

The patient appears a good colour and is able to give you a history.

Stab wound

There is an obvious isolated stab wound to the chest with no active bleeding.

Observations

His observations are:

Respiration rate 18

SpO2 98%

Not on oxygen: Air

Blood pressure 114/78

Pulse 88

Consciousness level A

Temp 36.2