A 50 year old chronic smoker attended the outpatient department with
complaints of chronic productive cough, dyspnoea and wheeze. A chest X-
ray was ordered and reported as hyperinflated lung with flattened
hemidiaphragm and a small cardiac silhouette. Full blood count shows an
increase in haematocrit.

A 29 year old woman has been short of breath for the last 15 hours and is
feeling unwell. An arterial blood gas is taken:PaO2 8.8 kPa
PaCO2 3.2 kPa
pH 7.50
Bicarbonate (HCO3-) 20 mmol/L
Normal Values:
PaO2 > 10 kPa
PaCO2 4.7-6 kPa
pH 7.35 – 7.45
Bicarbonate (HCO3-) 22-26 mmol/L

A 21 year old lady who smokes has a history of wheezing, chest tightness
and coughing at night. She also notices these symptomsoccur when she
goes out in the cold and breathes cold air.

A 45 year old man has been having a productive cough for the past 3
weeks. He has been having a fever since then. He has not gone to work for
the past 2 weeks as he feels too unwell. He presents to the hospital with
chest pain and shortness of breath. On auscultation, there is decreased
breath sounds on the right upper lobe with crackles. Percussion is dull in
the same area. He has a temperature of 39 C, a respiratory rate of 28
breaths/minute and a pulse rate of 110 beats/minute. His blood results are
as follows:
Haemoglobin 129 g/L
White cell count 15 x 109
/L
Platelets 450 x 109
/L
CRP 110 mg/L

A 24 year old male is admitted with acute exacerbation of asthma. He is
treated intiated with 100% oxygen. He continues to deteriorate. What is
the SINGLE most appropriate next step in management?

A morbidly obese 60 year old man has a right hemicolectomy for a tumour
of the caecum 4 days ago. He suddenly becomes breathless, dizzy and
describes chest discomfort. The chest discomfort worsens when he takes
a deep breath. On examination, he has good air entry on both lungs. His
oxygen saturation is 90% on room air and he has a pulse rate of 110
beats/minute. A chest X-ray was performed and was reported as normal.
An ECG shows sinus tachycardia

A 55 year old woman with a persistent cough and history of smoking
develops left sided chest pain exacerbated by deep breathing. She has a
temperature of 38.2 C and basal crackles are heard on auscultation.

A 24 year old male is admitted with acute severe asthma. He is treated
initiated with 100% oxygen, nebulized salbutamol, and IV hydrocortisone.
Ipratropium bromide was added to nebulizers. Despite the initial treatment
there has been no improvement.

A 28 year old male is admitted with acute exacerbation of asthma. He has a
temperature of 38.1 C and a productive cough. He is treated initiated with
100% oxygen and salbutamol nebulizers. Despite treatment, his oxygen
saturation is 88% and respiratory rate is 34 breaths/minute.

A 59 year old man with a medical history of chronic obstructive pulmonary
disease presents to the Emergency Department with breathlessness. He
finds it extremely difficult to breathe while in the supine position and has to
sit up in bed or in a chair at night due to his severe dysponoea. His
respiratory rate is 30 breaths/minute and his heart rate is 110 beats/minute.
His oxygen saturation on presentation was 89%. An arterial blood gas test
was done for him and he was commenced on 100% oxygen however, he is
still dyspnoeic. The results of his arterial blood gas are as follows:pH 7.20
PaO2 11.6 kPa
PaCO2 9.8 kPa

A 24 year old man presents with acute respiratory distress after being
stabbed in the back. The trachea is not deviated, but he has engorged
neck veins and reduced air entry on his right chest. He has a blood
pressure of 80/50 mmHg, a pulse of 135 beats/minute, and a respiratory
rate of 35 breaths/minute.