Acute Respiratory Distress Xn

Distressed

Step 1: View clinicals

A 60 year old man with a history of intermittent rectal bleeding for several months is admitted after his hemoglobin level is found to be 5.5 g/dL. He is not bleeding at the time of admission. A single unit of packed red cells is transfused cautiously over 4 hours, with a single dose of furosemide administered mid-transfusion. Half an hour after the transfusion he started to complain of breathlessness, fever and profuse sweating.


Step 2: Order all relevant investigations

Chest X-Ray

Bilateral pulmonary infiltrates are noted. The cardiac silhouette appears normal.

Arterial Blood Gases

FiO2: 60% (on oxygen via face mask) PO2: 60 mmHg PCO2: 35 mmHg pH: 7.36 HCO3-: 22 mmol/l SaO2: 83%

Full Blood Count + DAT

WBC/DC: 7,000/mm3 Hb: 7 mg/dL Hct: 25% Platelets: 350,000/mm3 Direct Antiglobulin Test: negative

ECG

The ECG appears completely normal.


Step 3: Select appropriate management

CPAP Ventilation
Diuretics
Nebulize with Adrenaline
Antibiotics


Score: ★★☆