Elderly gentlemen with severe SOB from acute exacerbation of pulmonary fibrosis for 2-3 hours before calling ambulance. Patient on home O2 via nasal prongs. Arrive and patient is in a lot of distress, appears very SOB and very restless. RR 40, HR 120, BP 150/90, SPO2 78%. Only other medical history is longterm asymptomatic AF. No chest pain. No illness lately. Temp normal. Lungs both clear on auscultation. Nothing abnormal on 3-lead (apart from AF).
Started him on an acute mask @ 5L and this improved SPO2 to 85% but didn't improve SOB or agitation. Moved up to a reservoir mask @ 10L and saw dramatic improvement. RR decreased, SOB virtually disappeared and SPO2 came up to 97%. He became much more relaxed and we took him through to hospital. No issues the whole transport until 2min out of hospital when his RR and SOB increased dramatically even on the reservoir mask. In ED he went straight to resus.
What I was wondering is if he had deteriorated earlier would he have been a candidate for PEEP? We generally only use PEEP on conscious patients if they have pulmonary oedema so would it even help someone with pulmonary fibrosis?
Edit: I just saw the Patient Care area so apologies if this is in wrong area.
Edited by HarryM, 12 August 2012 - 09:43 AM.