Critical Care SBAR
I. Situation
Date: August 15, 2050
Time: 14:30 hrs
Patient: Johnathan Michaels
Age: 67
Admitted To: ICU, Bed 7
Primary Diagnosis:
Acute Respiratory Distress Syndrome (ARDS) secondary to pneumonia.
Summary:
The patient was admitted to the ICU after developing severe respiratory distress despite BiPAP support in the Emergency Department. Currently intubated and mechanically ventilated. He is hypotensive despite fluids and requires vasopressor support.
II. Background
Past Medical History:
Hospital Course:
The patient presented to the ED three days ago with a fever, cough, and shortness of breath. He was diagnosed with pneumonia and started on IV antibiotics. His condition deteriorated rapidly with worsening oxygenation, and he was intubated and transferred to the ICU for ARDS management.
Current Medications:
Medication | Dose | Route | Frequency |
|---|
Norepinephrine | 8 mcg/min | IV | Continuous |
Midazolam | 2 mg/hr | IV | Continuous |
Ceftriaxone | 1g | IV | q24h |
Insulin Sliding Scale | As per protocol | Subcutaneous | As needed |
III. Assessment
Respiratory: The patient is currently on ventilator settings of FiO2 60%, PEEP 10 cm H2O, and tidal volume 6 mL/kg. His ABG shows pH 7.32, PaCO2 55, PaO2 68. The patient is on the verge of requiring a higher PEEP and FiO2 for oxygenation improvement.
Cardiovascular: The patient is requiring escalating doses of norepinephrine for MAP > 65 mmHg. His most recent BP is 85/52 mmHg, with a heart rate of 115 bpm.
Neurological: Sedated on midazolam infusion; no spontaneous movement. GCS 3T due to intubation.
Renal: Urine output decreased to 20 mL/hr over the last two hours. Creatinine has risen from 1.1 to 2.3 in the last 24 hours, suggesting possible acute kidney injury.
Infectious Disease: Persistent fever despite antibiotics. Blood cultures are pending, though a recent chest X-ray shows worsening infiltrates.
IV. Recommendation
Respiratory: Consider increasing PEEP to 12 cm H2O and re-evaluating ABGs after one hour. Monitor for barotrauma.
Cardiovascular: Initiate second-line vasopressor (vasopressin) at 0.03 units/min if BP remains unresponsive to norepinephrine.
Renal: Consider nephrology consultation for possible CRRT initiation if urine output remains low. Ensure adequate fluid resuscitation while balancing respiratory status.
Infectious Disease: Review pending blood cultures and consider broadening antibiotic coverage if cultures remain negative and fever persists.
Neurological: Continue sedation protocol; reassess sedation needs in 12 hours.
Prepared by: Dr. [Your Name]
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