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Further comments Patients with asthma still die. It is important to remember that early review by the ICU is important. If the patient is admitted in extremis or does not improve with treatment, get help. The move to the ICU should be a cool elective decision, not a panic when the patient is close to respiratory arrest. Important pointers to a deterioration may include: • previous admission to an ICU/HDU; • exhaustion, feeble respirations, confusion or drowsiness; • deteriorating PEFR; • worsening or persisting hypoxia or hypercapnia.

Other tests ›Fig. 18 CT angiogram of the chest showing a clot in the proximal pulmonary artery (arrow). imaging investigation provided the CXR is normal, there is no significant cardiopulmonary disease, standardised reporting criteria are used and a non-diagnostic result is 38 MMC Core Curriculum always followed by further imaging. The presence of chronic lung or cardiac disease makes interpretation of ventilation–perfusion scans very difficult if not impossible (Fig. 19). Routine haematological and biochemical tests should be performed: are there any clues to a systemic disease that might predispose to PE?

He is complaining of breathlessness. The nursing staff report that his saturations remain persistently low and he is Other methods of circulatory support deteriorating despite increasing • Inotropes: evidence for their benefit is limited. They can obviously raise the arterial pressure, which looks better on the observation charts, but there is no compelling evidence that they improve prognosis. The resulting high systemic vascular resistance means they should be used with caution and for a limited time only because they can lead to a further decrease in end-organ tissue perfusion.

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Acute medicine by Coll.


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