You send off some bloods and do an ABG on room air:
- pH 0.42 (0.35-0.45)
- pCO2 3.1 (4.4-6.5)
- pO2 10.0 (10.0-15.0)
- HCO3 27 (24-28)
You paid attention in med school and correctly identify that your patient is hyperventilating. You expected the pO2 to be slightly higher in a patient who is hyperventilating so this time you put the patient on oxygen yourself.
You aren’t too bothered about the radiation of one plain film in comparison to the chance that you may be missing something. However radiology not-so-kindly tell you that it is not routinely recommended in the absence of:
- Suspected pneumomediastinum or pneumothorax
- Suspected consolidation
- Life-threatening asthma
- Failure to respond to treatment satisfactorily
- Requirement for ventilation
Remembering the distress on your patient’s face you start writing them up for:
Salbutamol 5mg nebs, ipratropium 500mcg nebs, hydrocortisone 200mg IV
Salbutamol 2.5-5mg nebs, saline 5mg nebs, prednisolone 50mg oral
Salbutamol 5mg nebs, ipratropium 5mg nebs, prednisolone 40mg oral