Case Analysis of Bill
Case study: Bill
Bill, a 40?year?old, has had asthma since childhood. He has experienced many hospitalisations and
required long?term oral steroids.
He presents to the emergency department (ED) with acute exacerbation of his asthma that he believes
has been triggered by a known allergen. At home he increased his salbutamol with little effect. He is
now anxious and agitated.
On presentation to the ED his clinical assessment reveals:
Noted use of accessory muscles
RR 36 breaths/minute
HR 150 beats/minute
BP 142/88 mmHg
Height 170 cm
Weight 80 kg
Management in the ED includes:
Oxygen via a non?rebreather mask at 15 L/min
Salbutamol, ipratropium bromide via nebuliser
First ABG Suggested normal
pH 7.25 7.35?7.45
PaO 60mmHg 80?100mmHg
PaCO 55mmHg 35?45mmHg
HCO 22mmol/L 22?26mmol/L
Base excess ?2 ?2 to +2
No improvement so further management of:
Adrenaline via a nebuliser
Salbutamol as an intravenous infusion
IV normal saline at 100 mL/
here is the format of the essay.
Part A (approx. 1000 words)
Analyse Bill?s respiratory changes in relation to his current clinical condition. Your analysis should include the mechanics of breathing, intrapulmonary pressure,
physical factors and the ramifications for V/Q ratio.
Part B (approx. 750 words)
Discuss Bill?s haemodynamic changes, including the factors contributing to these changes, potential impact on cardiac output, and the particular adrenergic receptors
Part C (approx. 750 words)
Analyse and interpret Bill?s arterial blood gases, including buffering systems, regulatory mechanisms, pressure gradients, and solubility of gases. Relate your
interpretation to the oxyhaemoglobin dissociation curve.