Billy a 32-year-old male was admitted to the intensive care unit (ICU) with a suspected overdose of tricyclic antidepressants. He is obese (weight 160kg, height 172cm) and has a history of depression and chronic back pain for which he takes oxycodone.

On admission to the emergency department, Paramedics were maintaining Billy‘s airway with a combination of jaw thrust, head tilt and guedel airway. Billy was obtunded with evidence of vomitus on his clothing. There was an attempted intubation on route which was unsuccessful.

Billy‘s initial observations were
– Temperature 35.5°C
– Heart rate 140 bpm
– Blood pressure 100/50 mmHg
– Respiratory rate 22 b/min, shallow and laboured
– Oxygen saturation 92% breathing spontaneously via a bag valve mask with oxygen at 15 L/min
– Auscultation of lung sound revealed decreased air entry bilaterally and respiratory wheezes
– Arterial blood gas: pH 7.21, PAC02 68 mmHg, PA02 90 mmHg, HC03 26M Eq/L, Sa02 94%
– GCS8, (E1,V3,M4)

Question 1: (1500 words)
Describe the pathophysiology of acute respiratory distress syndrome, including a systemic interpretation of the blood gas. (Consider Pa02/Fi02 – P/F ratio, assume PEEP is 5 cmH2O). In view of Billy‘s current clinical condition outline the proposed ventilation parameters you would suggest including rationales.

Using current evidence from literature, critically analyse one of the mechanical ventilation strategies/parameters that you have chosen.

Question 2: (1500 words)
Twenty-four hours after admission to the ICU Billy’s condition deteriorates. His current observations are:
– Temperature 39 degrees Celsius
– Sinus tachycardia with a heart rate of 130 b/min
– Arterial Blood pressure 85/55 mmHg
– Pulse pressure variation or systolic volume variation (PPV or SVV) 15%
– Central Venus pressure 5 mmHg
– Bounding peripheral pulses
– Urine output 20mls for the last hour and 80mls total for the last four hours

Discuss Billy’s assessment data, incorporating the determines of cardiac output and the underlying pathophysiology of severe sepsis. Using current evidence critically analyse the best practice therapy in relation to fluid resuscitation and vasopressor management.

Marking guide to follow when writing assessment:
ADVANCED KNOWLEDGE 40%
Demonstrates advanced theoretical knowledge relevant disease pathophysiology, the critical ill patient and the treatment interventions discussed.
In your response, you have:
– Challenged the theoretical and/or conceptual knowledge basis of key ideas, contexts, frameworks for practice.
– Evidenced findings and conclusions grounded in an extensive range of literature.
–
CRITICAL THINKING AND ANALYSIS (CRITIQUE, ANALYSE AND EVALUATE) 40%
Demonstrates advanced cognitive skills and knowledge of rational is related to the chosen interventions. Evidence of extensive critical analysis and evaluation and its application to the clinical context.
Conclusions are justified using evidence-based research/literature.
Reference to patient is the case study is throughout demonstrated.
In your response, you have:
– Sourced, analysed, and synthesised information/data to construct eminent knowledge (as applied to practice).
– Critically synthesised evidence drawing from an extensive range of relevant, seminal and all current sources.
– Articulated a persuasive position or recommendation talking into account contextual complexities.
– Integrated critical and evaluated the credibility and rigour of available evidence to develop a coherent and analysis.
– The treatment interventions are critically discussed with comprehensive application to patient case study.

PROFESSIONAL WRITING/COMMUNICATION 20%
Demonstrates clarity of expression and adheres to information literature standards in communication of health data and information to others.
In your response, you have:
– Presentation of document meet expected professional standard
– Writing style is analytical and coherent when critical of multiple perspectives
– Logical and succinct structure to the content
– Constantly meet expected standard of English conversations of grammar and spelling
– Acknowledges all sources
– Meet APA referencing standards with no errors
– Uses language of the discipline
– Uses non-discriminatory and culturally safe language

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