LaPoint 1

Case Studies

Case #1:
62-year-old, 65-kg woman with ARDS from aspiration pneumonia
Her ventilator settings are PRVC 400, RR 18, PEEP 8, and FIO 100%. She is dyssynchronous
2
with the ventilator and her plateau pressure is 37 mm Hg.
She is on propofol at 50 mcg/kg/min, which has been ongoing since admit four days ago.
She is also on norepinephrine 0.1 mcg/kg/min and she was just started on steroids.
What do you want to do next? Why? What complication is this patient at risk for?
The patient is also noted to be in significant renal failure with a serum Cr of 3.5 and K+ of 5.9.
Does this change your plan? What medications should be avoided?
Case #2:
38-year-old, 60 kg female with a history of multiple sclerosis undergoes rapid sequence
intubation with the use of succinylcholine 90 mg IVP for acute respiratory failure.
What electrolyte disturbance is most likely to occur?
What is the patient at risk for?
What are suggestible alternatives?

Case #3:
You arrive for your night shift and assess your patient, a 55-year-old, 80 kg male on mechanical
ventilation. During report you received information that the patient had been paralyzed the
day before for status epilepticus that was refractory to previous treatments. Within the same shift
hand off you are told that the patient has a 2 out of 4 twitches on a mA of 30 via the right ulnar
nerve. The prescribed neuromuscular blockade as reported is Vecuronium @ 1.5 mcg/kg/min.
Upon first rounds, you note that the patient now has 0 out of 4 twitches on a mA of 30 to the
right ulnar nerve with the drip running at the previously stated rate.
What are your first assessments to make? What are your concerns for this patient? What are
your first actions?