Patient 1: Joseph Knecht

A 65 year old man with a history of COPD is brought to ED by LAS complaining of severe shortness of breath. Saturations on room
air are 75%.

HPC
Gradually increasing shortness of breath over 3/7. Acute deterioration over 12hrs
Weak ongoing cough, producing a moderate amount of thick, yellow secretions

PMH
COPD

DH
Tiotropium
Salmeterol
Beclometasone

SH
Retired salesman, lives at home with his wife. Fully independent. 40 pack per year history of cigarette smoking.

O/E
Alert and oriented but shows signs of fatigue. Speaking in incomplete sentences. Active use of the sternocleidomastoid muscles.
Pitting oedema of the ankles

RR: 35 to 40 breaths/min
HR: 135 beats/min
BP: 185/110 mm Hg
SpO2: 75% on room air
Temp: 37.1° C

Breath Sounds:
Bilateral wheezes, crackles in the bases, hyperresonance to percussion bilaterally

Investigations

CXR: Increased bilateral radiolucency, flattened diaphragm; scattered infiltrates both bases.

ABG on FiO2 0.30

pH 7.21
PaCO2 8.1
PaO2 7.3
Na+ 130
K+ 5.2
Ca++ 1.29
Glu 7.5
Lac 4.0
Hct 22%
HCO3 std 27.0
BE -5
SO2c 82%
THbc 95

Treatment in ED
Back to back nebulisers with little effect

Mr Knecht is 128 cm tall, and weighs 67kg.

Patient 2: Harry Haller

A 19 year old man with no past medical history, brought to ED following an RTA. There is an evident large haematoma to the left
temple. On arrival he is GCS 14/15, with confused speech. He quickly becomes more confused and combative, and the decision is
made to intubate.

PMH
Nil

DH
Nil

SH
Social media influencer. Non-drinker, non-smoker.

O/E
Pre-intubation observations:
RR: 14 to 18 breaths/min
HR: 100-120 beats/min
BP: 119/80 mm Hg
SpO2: 98% on room air
Temp: 35.9° C

Mr Haller is 186 cm tall, and weighs 85 kg.

Patient 3: Emil Sinclair

Mr Sinclair is a 32 year old man, who was admitted to hospital 3 days ago with an opportunistic pneumocystis pneumonia. His
oxygenation requirements have steadily increased since admission, and he was started on BiPAP for hypoxic hypercapnic
respiratory failure yesterday, but has continued to deteriorate. After lengthy discussion, the decision has been made to intubate.

PMH
HIV+

DH
Anti-retrovirals
IVA 3/7

SH
Lawyer, non-smoker, non-drinker. Fully independent.

Investigations
CXR: bilateral opacities mid to lower zones

ABG on FiO2 0.80

pH 7.29
PaCO2 9.2
PaO2 8.1
Na+ 134
K+ 4.9
Ca++ 1.27
Glu 5.4
Lac 2.4
Hct 24%
HCO3 std 25.0
BE -4.8
SO2c 90%
THbc 101

Mr Sinclair is 180cm tall, and weighs 74kg.