Icu Case Study - 2940 Words

Case Study A 45 year old male was admitted to ICU following an exploratory laparotomy which showed a ruptured appendix and peritonitis. The procedure began as a laparoscopic cholecystectomy but the initial finding was pus throughout the peritoneal cavity and a normal gallbladder. An open exploratory laparotomy where a ruptured appendix was discovered which was removed and a washout was performed. The patient had a two day history of abdominal pain prior to his admission through AE. He had no previous medical or surgical history. The patient smoked 20/day and drank alcohol at the weekends. Once admitted to ICU, he was intubated and ventilated on bilevel ventilation and sedated with propofol and fentanyl. In theatre he received two†¦show more content†¦Suctioning resulted in moderate to large amounts of white sputum. The patients wife stated that he had been suffering from a cold for one week prior to admission. Therefore an increase in PEEP (Hi and Lo) was required to recruit the alveoli and aid in good gas exchange. (Dellinger at al, 2007) It is recommended that positive end expiratory pressure is set to avoid extensive lung collapse on expiration. (Dellinger et al, 2007) Maintaining pressure and spontaneous breathing resulted in an increase in arterial oxygenation and helped prevent a deterioration in pulmonary gas exchange. (Putensen et al 2006) Studies have been carried out to determine whether high PEEP increases patients outcomes. These include the ALVEOLI study and the Lung Open Ventilation (LOV). These studies do not show an improvement on mortality with the increase in PEEP however show a decrease in days on the ventilator. (Mercat et al 2008) The patients right side was worse than the left on the CXR and auscultation. Therefore he was being positioned right side up and his back on pressure area cares. Repositioning patients not only protects the patients skin but it also improves gas exchange and decrease the risk of ventilator acquired pneumo nia. (Deutschmann and Neligan, 2010) Positioning the patient with the good lung down may improve paOâ‚‚ and aid in the drainage of secretion. (Deutschmann and Neligan, 2010) Elevating the head ofShow MoreRelatedCase Studies13817 Words   |  56 PagesCASE STUDY #1 A Job Search Dilemma Eric, a second-semester senior, is looking for a job. Anxious about finding work in the worst economy in decades, he sends out scores of resumes for a wide variety of positions. The first call he gets is for a position that doesnt really interest him, but he figures he should be open to every opportunity. He schedules an interview, which he aces. In fact, the recruiter offers Eric the job on the spot. He would like Eric to start as soon as possible. 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