Level 6, module 1, assessment 1 – Clinical scenario
Instructions
1. Critically analyse the data below making reference to appropriate pathophysiology and the current ICU management.
(70%)
2. Critically discuss potential sources of error in the measurement or assessment of any of the items of data below. The answers should also refer to how any errors could affect subsequent interventions.
(30%) 3000 words maximum. Submit via Moodle by 5 pm on Wednesday 20th October.
Scenario
Mary Jones, a 68–year–old lady has just been admitted to Intensive Care from the Emergency Department (ED). She was found collapsed at home by her son who called for an ambulance.
Her son saw her the day before and went round after she appeared confused on the phone. She had been feeling unwell for a few days and had complained of pain on passing urine. She has had no cough or respiratory symptoms. Her son reported she went out little and she is considered a low Covid risk (negative lateral flow test in the ED).
Mrs Jones has Type 2 Diabetes Mellitus, diet controlled, but often had high blood glucose. She is known to be hypertensive (her ‘normal’ BP is 145/86 mmHg). Her husband died 3 months ago and her son says she hasn’t been taking good care of herself, or eating properly, since then. Mrs Jones is 1.7 m tall with an actual body weight of 56 kg.
On presentation to the ED, she was pyrexial and hypotensive. Her GCS was 9/15 (E2, V2, M5) and she was noted to have vomited. She arrived to ICU intubated, ventilated, had been administered antibiotics and 2 litres crystalloid and has had a wide bore NG inserted.
In ICU she then had a right internal jugular central line and a right radial arterial line
RESPIRATORY
Mechanical ventilation: Pressure Control Ventilation + Pressure Support
Set respiratory rate: 18 bpm FiO2: 0.40
Set inspiratory pressure: 20 cmH2O Pressure Support: 10 cmH2O PEEP: 5 cmH2O
Total rate: 18 bpm Total Minute Volume: 7.4 L Peak Inspiratory Pressure: 26 cmH2O
SpO2 = 91% EtCO2 = 4.8 kPa
Mrs Jones currently has no cardiovascular support. Peripherally she’s quite warm.
RENAL Urine output in the hour since arrival on ICU was 20 ml
NEUROLOGICAL
Sedated with fentanyl and propofol.
Pupils equal and reactive to light.
RASS = –2
GCS = E2, VT, M5
Blood results from ED samples
BIOCHEMISTRY
K+ 3.1 mmol/L
Na+ 132 mmol/L
Magnesium 0.78 mmol/L
Calcium (Total) 2.13 mmol/L
C–Reactive Protein 28 mg/L
Creatinine 110 μmol/L
Urea 8.9 mmol/L
Glucose 11.4 mmol/L
Albumin 25 g/L
HAEMATOLOGY
WBC 23.2 x 109/L
Platelets 65 x 109/L
Neutrophils 18.0 x 109/L
CLOTTING
INR 1.1
APTTr 1.0
Fibrinogen 4.2 g/L
A clinical scenario. We are to critically analyse the data supplied linking it to the patient. For example analysing blood pressure, what are its limitations? In getting the blood sugar, what are its limitations? Is it always accurate? The Abg results are they 100% accurate? What are its limitations? The sats probe are they accurate in giving the accurate oxygen saturation of the patient?
