Question

P.R., a 66-year-old woman who has no history of respiratory disease, is being admitted to your intensive
care unit (ICU) from the emergency department (ED) with a diagnosis of pneumonia and acute respiratory
failure (ARF). The ED nurse tells you that P.R. was stuporous and cyanotic on her arrival to the ED. Her
initial vital signs were 90/68, 134, 38, 101° F (38.3° C) with an Spo2 of 53%. She was endotracheally intubated
orally and placed on mechanical ventilation and has equal breath sounds. Her ventilator settings
are synchronized intermittent mandatory ventilation of 12/min, tidal volume (VT) 700 mL, Fio2 0.50, positive
end-expiratory pressure (PEEP) 5 cm H2O. The nurse tells you P.R. had an initial chest x-ray (CXR) examination
that confirmed the diagnosis of pneumonia, but she needs an additional CXR examination stat.

Please help me write step by step SBAR.

Answer 1

So here we have a patient 66 year lady a case of PNEUMONIA who presented with ACUTE RESPIRATORY FAILURE in EMERGENCY DEPARTMENT.

SBAR, What is SBAR.? It is acronym which stands for

S - SITUATION

B - BACKGROUND

A - ASSESSMENT

R - RECOMMENDATION

SO now coming to SBAR of this case

SITUATION is that we have a emergency case whi is 66 year old female presented in respiratory distress with vitals of Pulse -134/min, BP - 90/68mm of Hg, SpO2 - 53% , Temperature-101 F and she is cyanosed and stuporous. I am concerned about patients low saturation, tachycardia, hypotension and altered sensorium.

BACKGROUND is that patient is stuporous with normal skin temperature. After assessment in emergency room, now patient is on MECHANICAL VENTILATION via endotracheal tube with ventilators settings of 12 breaths/min, tidal volume 700ml, FiO2 - 0.5 and PEEP- 5Cm of H2O with CXR suggestive of PNEUMONIA with no past history of respiratory disease.

ASSESSMENT - my assessment is that it is a case of ACUTE RESPIRATORY FAILURE SECONDARY TO PNEUMONIA who is now on MECHANICAL VENTILATION with NEUROLOGICAL dysfunction secondary to hypoxia. Patient's condition is unstable.

RECOMMENDATION- my recommendation would be to continue mechanical ventilation, to start treatment for pneumonia, keep a watch on GCS and to involve neuro physician for his opinion, to do all routine investigations like CBC, RFT, LFT, ABG, CXR to confirm after intubation, to counsel patients relative about the prognosis and to keep a close monitoring.

Thank you.