Bronchiolitis

Four days ago, an older sibling who recently started pre-school had a cold. The next day, Zarah fell sick. She has had a runny nose and cough but seemed to be doing fine until yesterday when she did not eat or drink very much. This morning, she had some noisy breathing, and her chest looked funny while she was breathing. When it did not go away after a couple of hours, Zarah’s parents called 811 for advice. They were directed to go to the emergency department. The patient will progress through escalating respiratory support and eventually require intubation and transfer to higher level of care.

Tracheostomy Emergency

48-year-old male with a recent tracheostomy presents with sudden onset respiratory distress. The patient is unable to be oxygenated or ventilated through the tracheostomy tube. The team must recognize that the tracheostomy tube is either obstructed or displaced. Attempts to correct tracheostomy obstruction with suctioning and cuff deflation are not successful. Removal of the tracheostomy tube is required, followed by either oral intubation or placement of a new tracheostomy tube. The patient improves once oral or stomal intubation is performed. If tracheostomy tube is not removed, the patient worsens and goes into cardiac arrest secondary to respiratory failure.

Airway Obstruction from FB

This case involves a 60-year-old male patient who arrives VSA in PEA after collapsing while eating dinner with family. The collateral history included that he was suspected to be intoxicated. The patient is difficult to bag with EMS. The learner will have to work through the can’t ventilate/can’t oxygenate scenario once they identify that BVM is ineffective. 

COPDE with Pneumothorax

A 68-year old man with COPD requiring home oxygen presents with respiratory failure. He is hypoxic, hypercarbic and agitated and will require intubation. Dissociative-dosed ketamine and BiPAP can facilitate pre-oxygenation. After a successful intubation, the high pressure alarms on the ventilator will go off. The team leader must troubleshoot the high ventilation pressures until they find and treat a tension pneumothorax.