June Case-Chasing Zebras

Send us a text

Catch the full episode on YouTube: https://youtu.be/tFxQiYzhEzQ?si=0DAQSbvsWG9o28aV

Special thanks to Emergency Medicine Specialists: 

https://ems-wi.com/

Episode Transcript

(00:00):
my name is Matthew Treat, andI'm a physician assistant with
Emergency Medicine Specialists.
I'd like to introduce you to ashort educational series called
Chasing Zebras.
In this series, we will featurethe cases you submitted to the
educational committee.
Thank you to Dr.

(00:37):
What's up?
This is Dr.
Ford, ER provider with EMS, aswell as host of the podcast
Pulse Check Wisconsin.
And this is the officialtakeover of the amazing
educational series, ChasingZebras, brought to you
originally by Matt Treat.
Today, we're going to bring youa case by one of our awesome
colleagues, Dr.
Laurie Benson.

(00:58):
And with that being said, let'sgo ahead and get into it.
Patient has a 22 year old femalewith a past medical history of
asthma.
Who's presenting with complaintsof worsening asthma symptoms
over the last 24 hours.
The patient arrives, combativealtered as well.

(01:18):
EMS has attempted to give her aC-PAP of which she removed.
They also gave her aSubcutaneous Epinephrine and
dexamethasone,Duo Neb andmagnesium prior to arrival.
They're unsure how muchmedication she received because
the infiltrated on arrival.
Patient's past recordsdemonstrate that she is
prescribed.

(01:39):
an albuterol inhaler.
Was she states that she's beenusing all day.
Patient states that she ran outof the albuterol inhaler and was
using an old inhaler.
Father and the patient's friendstates that the patient just got
a new cat.
During her course, the patientwas given multiple doses of
continuous albuterol.
The time of arrival.

(01:59):
She was given magnesium andadditional Solu-Medrol.
The patient was placed on bi-papby.
The provider.
Unfortunately, however, thepatient continued to be
combative.
The decision was made toultimately intubate the patient
for respiratory and airwaysecurity.

(02:20):
After the patient was intubated.
The decision was made to bag thepatient as the patient's breath
sounds were still very tight.
Patient's chest x-ray was clear.
With no evidence ofpneumomediastinum pneumothorax.
The patient's blood gas revealsevidence of a respiratory
acidosis with a very high PCO,two.

(02:41):
As noted.
The patient was decidedlyadmitted to the ICU.
Throughout the day, the patientdevelop worsening hypercapnia
and worsening auto peep, whichrequired her to be taken off of
the ventilator often.
Patient was started on empiricantibiotics and bronchoscopy was
performed.

(03:03):
The patient did not demonstrateany signs of any large mucus
plugging.
However, due to her lack ofimprovement and difficulty with
ventilation.
Again, the patient had to betaken off of the vent often To
decompress the lungs.
The patient was transferred to.
FML H to place her on VV ECMO.

Speaker (03:23):
Which allow for respiratory and circulatory
support and gas exchange tooccur outside the body.
So this case was a key exampleof both the ER provider, as well
as the ICU providers doing thebest that they can and taking
the next step to elevate thepatient's level of care.

(03:44):
When needed.
This should be the case foradult and pediatric patients.
Remember that there arealgorithm's available to you for
asthma management.
And as a reminder, so that's it.

(04:11):
So the key in this is All asthmais not typical asthma.
If you feel like you need toescalate to the next level of
care, feel free to do that.
Push that button again.
If you need any information onpediatric asthma, check out the
algorithms.
If you need a copy, feel free toemail me should be available in
all your emails.
It should be available at allthe hospitals that we provide

(04:33):
care to as well.
So with that being said.
Thank you to the EducationalCommittee.
Thank you, Dr.
Benson.
Thank you, Matt Treat, and I'llsee you guys on shift Peace.