You examine the patient further; there are no peripheral stigmata of respiratory disease. The patient is tachypneic with a respiratory rate of 32, is sat on the edge of the bed using accessory muscles and looks a bit panicked. She has no calf swelling.

While you were looking for signs of clubbing, a med student used the other hand to do an ABG because they were concerned about the patient respiratory function, but mainly because they needed to be signed off. The ABG was 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 enough attention in med school to 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 at this stage.

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