Viva 6

Respiratory

Scenario:   A 36-year-old female presents to the Emergency Department with a 2 week history of worsening shortness of  breath.   She has a  past  history of asthma and  schizoaffective disorder treated with olanzepine.
On arrival in ICU she looks distressed and is uncooperative.  She is tachypnoeic, tachycardic and hypertensive.
Her ABG on mask CPAP

PEEP

5cm H2O

FiO2

1.0

PaO2

51 mmHg

PaCO2

46 mm Hg

35 – 45

pH

7.32

7.35 – 7.45

HCO3

24 mmol/L

20 - 30

Introductory question:  What is your immediate management?

Disclaimer: the viva stem above may be an original CICM stem, acquired from their publicly available past papers. Or, perhaps it is a slightly altered version of the original CICM stem. Or, it is a completely original viva stem, concocted by the monstrously amoral author of Deranged Physiology for nothing more than his own personal amusement. In either case, because the college do not make the main viva text or marking criteria available, almost everything here has been confabulated. It might sound like a plausible viva and it could be used for the purpose of practice, but all should be aware that it does not represent the "true" canonical CICM viva station.