[Music] hi there my name's Leah I'm one of their A&E doctors how can I help hi Leah thanks for coming so quickly I'm Grace one of the nurses this is Callum he's 20 years old and he's just been brought in by ambulance with shortness of breath he's got a background of asthma but it's usually well controlled in the ambulance they gave him in nebulizer and he seemed a lot better but he's just now got really breathless I'm very worried about him I was hoping you could assess him yeah of course no worries thanks just let
me know if you need anything thank you hi Callum my name's Leah I'm one of the doctors I'd just like to give you a check over today to make sure your breathing's all right is that okay yes thank you very much I'm just going to start by checking your full name and date of birth Callum Smith 10th of July 2004 okay that's great and I'm just going to start off um just by having a little listen to your Airway so how is your breathing feeling at the minute I just can't catch my breath okay I'm
happy with this Airway cuz I can hear him talking to us I'm just going to move on to Assassin breathing whilst I'm doing that would it be okay to just get his oxygen saps and respiratory rate please yes of course Callum I'd like to start by having a listen to your chest is it okay okay if I just remove your T-shirt go ahead okay thanks okay I'm just going to start by having a feel of your wind pipe okay that feels all right I'm going to pop my hands on your chest if you just take
some big breaths for me okay now just have a tap on your chest okay and just breathe normally for me Callum okay his Ras rate is 32 and the oxygen saturation on 91% okay would it be right to put him on 15 lers of oxygen fire non re breathe mask please I'll do that right now Callum I'm just going to pop this oxygen on okay to help with your breathing go ahead okay now that he's un oxygen I'm going to do an arterial blood gas he was also quite Wheezy on examination of his chest so
I'm going to request a chest exray would you mind just preparing a nebulizer of Sal on it for Trum and I'll go and prescribe it yeah I'll do that now thanks very okay so looking at the arterial blood gas the pH is normal the pco2 is a little bit low and the Oxygen's normal but he is on 15 l of oxygen VI a non- rebreath mask okay so the airway looks Central and the lung Fields look clear I think this is probably a normal chest x-ray okay so now that we've given him the oxygen the
nebulizers I think we should just reassess to make sure that he's improving would it be okay if you just recheck his oxygen sets I'm respirat R and I will listen to his chest yeah of course thanks perfect the oxygen sats are now 95% and the rest rate is 27 okay that's great sounds like we're going in the right direction so we'll continue with the treatment we're just going to move on to assess circulation would it be okay to check his heart rate blood pressure and a fluid balance as well please of course thank you Callum
I'm just going to start by having a feel of your hands and checking your temperature okay yes [Music] okay okay Callum if you could just turn your head over to the left for me I'm just going to have a look at your neck okay that's that's great thank you you can turn your head back okay Callum I'm just going to have a little listen to your heart okay and then finally I just need to have a quick check of your legs okay there's only pain when I'm pressing on your legs no no pain okay there's
no swelling so the blood pressure was 110 over 88 and the heart rate was 95 okay that sounds all right um on examination he was perfectly warm and well profused his heart sounds would normal and there's no peripheral EMA and so I'm just going to put a canul in and take some blood tests would you mind just doing an ECG please yeah of course thanks okay so I'm going to take a full blood count use the knes lfts and a [Applause] CR here's colum ECG thank you okay so it's sinus rhythm the rate is 95
I can't see any abnormalities there okay I'm just going to move on with my assessment I'm going to check his conscious level and his pupil would you mind just checking his blood sugar whilst I'm doing that and can I borrow your pen torch please yeah of course thank you okay Callum I'm just going to shine a bright light in your eyes for a second okay that's great and can you tell me whereabouts you are at the minute yes I'm in hospital okay thank you so that blood sugar was 5.8 okay thank you very much um
I'm just going to move on to assess his tummy and his legs would you mind just checking his temperature please yeah of course thanks um Callum do you have any pain in your tummy at the minute no no I don't okay so ideally I'd lay you a bit more flat to check your tummy but because you're struggling with your breathing I'm going to keep you sat where are I'm just going to have a little feel of your tummy there okay okay okay and then I'll just have a little look at your legs can I just
lift your gown up a bit yes thanks okay there's no rashes there Callum I'm just going to pop this in your ear to check your temperature okay okay so the temperature was 36.8 okay thanks very much um so that completes our assessment um based on the investigations and examination findings it sounds like there's a non-infective exacerbation of asthma and we've already treated Callum with some oxygen and some nebulizers I think we probably need to give him some steroids so I'm just going to prescribe some oil prisone 40 milligrams if you wouldn't mind getting that for
me yeah no problem thank you hi Leah he's had his predas alone and I put up another cell beable nebulizer okay that's great thank you um I'm just going to go and hand over to our senior and just to let him know about what's been going on um would you mind just repeating the patient's observations whil I'm away and then I'll come back yeah of course thanks hi there it's Dr farington it registar on call hi there my name is Leah I'm one of the doctors in Ed um I was just calling to discuss um
a gentleman who's come in with an acute severe exasperation of asthma sure go ahead um so I've got a 20-year-old man he's called Callum Smith he does have a known background of asthma but he's coming today with a deterioration of his symptoms um his SATs were 92% on room a when he first came into the department that has improved to 95% on a 15 L non- rebreath mask and it stayed at 95% with some cbal nebulizers that we've given MH um on examination of his chest is globally Wheezy but we've done a chest x-ray which
shows that there's no other pathology um and a blood gas um was also normal aside from a slightly low carbon dioxide um on the rest of his assessment he is properly warm and well profused he's hemodynamically stable and his carves were soft non tender the rest of the examination was also normal um so in total we've given him two cbal nervs 5 milligrams each he's also had some otrum bromide um and we've just given him a start of predis loan um his rest ratees currently sat at 27 his hearts are still 95% um and his
chest is starting to settle so I'm planning to do a peak flow soon um but because of his SATs when he came in he does fall into the acute severe category for his exacerbation so I think he probably needs an IT review okay can I just clarify a few points what was the the respiratory rate originally um so it was 32 when he came in and it's now come down to 27 okay and the blood gas you mentioned that the oxygen levels were normal and the CO2 was low can I just clarify was that on
oxygen yes that was on the 15 liters non re breathe okay what are the vital signs at the moment um so his blood pressure is 110 over 88 his temperature is 36.8 his respiratory rate is 27 and his oxygen SATs and 95% um is currently on a Sabal nebulizer okay great and is is that oxygen driven yes it is yeah great okay so I think continue doing what you're doing with the backtack subut Mal nebulizers I'll be down right away that's great thank you very much check out the geeku Medics collection of over 1,000 osy
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