Acute respiratory failure

00:00

  • Acute respiratory failure
A 20-year-old man comes to a general practitioner office complaining of dry, irritating cough, shortness of breath, dyspnoea and increased limitation of physical activity over the past seven days. He has no other comorbid diseases. During examination, the patient is alert, fully orientated but obviously dyspnoic (unable to complete a sentence). On auscultation breathing is diminished in lower lung fields on both sides, tachypnoea. Cardiac rythm is regular, sounds without murmur, tachycardia. Oxygen saturation of the patient's blood is 88 %. What are you going to do next as a general practitioner?

I will measure CRP level. If it is < 8 mg/mL, the cause is probably flu and I will send the patient home to rest in bed.

Wrong answer

The patient is in great danger of one or more organ systems failure (respiratory system, circulatory system), and therefore it is necessary to provide an immediate transfer to hospital followed by hospitalization of the patient. CRP is an inflammatory marker positive during bacterial infection but maximum levels are reached after 48 hours. Negative CRP level in early phase of the disease doesn’t exclude bacterial infection.


Back

I will place the patient into the supine position and administer oxygen from gas cylinder trough a nasal cannula or a face mask (what is available at the GP). In case patient’s condition improves I measure CRP levels and decide the next steps according to the results.

Wrong answer

Supine position might intensify dyspnoea. For the patient with progressive shortness of breath, semi-sitting or sitting position is preferred. The patient is in great danger of one or more organ systems failure (respiratory system or circulatory system), and therefore it is necessary to provide immediate transfer to the hospital followed by hospitalization of the patient.


Back

I will place the patient into semi-sitting position and administer oxygen from gas cylinder trough a nasal cannula or a face mask (what is available at the GP). I will call EMS and measure CRP level.

Correct answer

The patient presents with worsening vital signs – major dyspnoea (inability to finish a sentence), low SpO2, tachypnoea and tachycardia. The patient needs monitored transport to hospital.


Continue

I will measure CRP level. In case CPR > 10 mg/mL, I will prescribe antibiotics and tell the patient to come back in 2 days.

Wrong answer

The patient is in great danger of one or more organ systems failure (respiratory system or circulatory system), and therefore it is necessary to provide immediate transfer to hospital followed by hospitalization of the patient.


Back

?

Help

CRP = C-reactive protein
EMS = Emergency medical services
GCS = Glasgow coma scale
GP = General practitioner×
 
RR

40 bpm

HR

115 bpm

SpO2

88 %

BP

110/70 mmHg

ECG

sinus rythm, regular pace, BPM 115 bpm

Examination:
Alert with GCS 15, unable to complete sentences due to dyspnoea, presents with tachypnoea. On auscultation of the lung fields breath sounds are diminished in lower zones on both sides.
Temperature: 37,1 °C.

Gly

not available

ABG

not available

CBC

not available

biochemistry

not available