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Consult: ICU for Respiratory Failure

Call the ICU fellow to advocate for a higher level of care for a patient with worsening respiratory distress, justifying the need for an ICU bed.

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    Review Clinical Case
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Review Clinical Case

Consult Briefing

Your Objective

You are the medical resident on the floor. Your patient with pneumonia is getting worse and you believe they are no longer safe on the medical ward. Your objective is to call the ICU fellow, Dr. Chen, to request an ICU bed. ICU fellows are the gatekeepers for a limited resource. You must present a clear, compelling case demonstrating that the patient's needs exceed what can be safely provided on the floor.

Patient: Eleanor Vance, 82F

  • Room: 1204
  • Code Status: Full Code

Case Summary & Data

History: 82F with a history of COPD admitted yesterday with community-acquired pneumonia. She was initially stable on 2L nasal cannula.

Hospital Course: Over the past 6 hours, she has had a steady increase in her oxygen requirement. She was placed on a non-rebreather mask, and is now on high-flow nasal cannula (HFNC) at 60L and 80% FiO2.

Pertinent Exam/Vitals:

  • Vitals: Temp 100.5°F, BP 105/60, HR 115, RR 32. Her SpO2 is 90% on 60L/80% HFNC.
  • Exam: She is awake but anxious. She is using accessory muscles to breathe and can only speak in 2-3 word sentences.

Initial Workup:

  • ABG (on HFNC): pH 7.32 / pCO2 50 / pO2 65. (Showing acute-on-chronic hypercapnic respiratory failure with hypoxia).

The Clinical Question

You have a patient who is on the maximum level of non-invasive oxygen support available on the medical floor and is still hypoxic, tachycardic, tachypneic, and showing signs of increased work of breathing. She is tiring out.

Your "Ask": Your specific request for the ICU fellow is: "I have a patient in worsening respiratory failure who has maxed out our floor-level support. I am worried she is going to tire out and require intubation. I'd like to transfer her to the ICU for closer monitoring and potential escalation of care."

Find a quiet spot with a good internet connection. Speak naturally — it’s fine to pause to think.