Name: Sheila Mae, Garcia

Case Scenario:
19-year-old, 80 kg (IBW) male crashed his car into a ditch at high speed Jake was
found unconscious at the scene after approximately 3 minutes; GCS 3 approximately 3
minutes; GCS 3 Regained consciousness in ambulance after rescue and resuscitation
for 2 minutes rescue and resuscitation for 2 minutes Assessed in ER with GCS now 8.
Question 1: For 5 points give a breakdown of GCS 8?
E: 3 V: 2 M: 3
 E: Upon assessment of the eye opening, patient responded only upon request
to open his eyes?
 V: In verbal response, the patient was asked regarding his name, the place and
time but answered with incomprehensible sounds and groans?
 M: In motor response, the patient exhibits decorticate posturing wherein the
hands is moving to the inner part of his body?

Assessment in ER revealed multiple traumatic injuries, Bilateral fractured femurs,

Pulmonary contusions noted to left, Patient stabilized in ER and went to OR for repair of
fractured femurs and Stabilized in ICU post-op

Question 2: For 5 points?

What factors of Jake’s situation place him at RISK for development of ARDS?
Bilateral fractured femurs are also a contributing factor for ARDS because they can
result in acute lung injury and progressive respiratory distress, refractory hypoxemia,
and pulmonary edema. Jake's numerous traumatic injuries can result in sepsis, which is
a contributing factor in developing ARDS. Because pulmonary contusions disturb the
lung, which can result in pneumonia, one of the major causes of ARDS, they increase
the chance of developing the condition.
Question 3: For 5 points?
What cause of ARDS would he most likely develop; intra-pulmonary vs extra-
pulmonary?

Extrapulmonary causes of respiratory failure include conditions that exclusively or

primarily cause respiratory failure by their effect on structures other than the lungs.
Intrapulmonary causes of respiratory failure include conditions that exclusively or
primarily cause respiratory failure by their effect on the alveolar epithelium with a local
alveolar inflammatory response.

Question 4: for 10 points?

What do you suggest for ventilator parameters for JAKE?

Mode? Volume limited mode

Tidal volume? 480 mL

Back up rate? 6000

FIO2? <200

Question 5: for 10 points?

What is the reason why this parameter’s is the best set up for Jake?

Since a pressure-limited mode will supply a stable airway pressure while a volume-
limited mode will produce a stable tidal volume in the majority of ARDS patients.
Because high tidal volumes may promote hyperinflation of relatively normal parts of the
aerated lung, we also utilized a modest tidal volume.

ABG Result: pH 7.32, PC02 49, P02 56, HC03- 22  B.E. -2 Sa02 88%, current fio2 on
mechanical vent 80%, AC Mode
QUESTION 6: Interpret the ABG, and give your final answer for 5 points
pH 7.32 acidic  ↑ Uncompensated Respiratory
PCO2 49 acidic ↓  Acidosis
HCO3 22 normal normal
Final Interpretation:

Question 7: What do you suggest for ventilator parameter changes? 5 points

Synchronized Intermittent Mandatory Ventilation
(SIMV)5 days after being in ICU with elevated PEEP, PC ventilation, LRMs q4h and a
trial of HFOV, BOB has recovered to the point where he is now on fio2 40%,
awake/alert, negative fever, result of serum electrolytes is NA 135, K 4, Cl 100. Patient
is on CPAP Mode.
Question 8: How do you assess Jake’s readiness to wean/extubate? 5 points
Jake's vital signs must first be checked to see if they are within normal ranges, and if
they are, we must obtain his ABG findings. Jake's readiness for weaning can be
determined via GCS score.
After 3 hours of weaning nurse Mica observed Jake vital signs is increasing: HR 154,
RR 54, Blood pressure and Spao2 is decreasing from 98% decrease to 88%, with Rapid
Shallow Breathing, Jake is on CPAP Mode.
Question 9: What is the next step for Jake? Base from the vital sign and
symptoms manifest in Jake Does he indicate readiness to wean? 10 points
Because Jake's vital signs are not within normal ranges and he is experiencing signs of
tachycardia, tachypnea, high blood pressure, and hyperoxia, he is not yet ready to be
weaned. Jake is not yet prepared for extubating since he is still in CPAP mode, which
means that air is being given constantly.