You put Mr. Romaine on supplemental oxygen via nasal cannula at 2 LPM. His SpO2 improves to 92% and his respiratory rate is 22. You listen to his lungs and note they are clear in the upper fields with fine crackles bilaterally in the bases. His skin feels cool and clammy, and he still feels short of breath.

Question

1. Recognizing a potential problem, you update the provider. Summarize what you would communicate in an ISBAR report.
The primary care provider agrees with your concern and provides you with the following orders.
Furosemide 40 mg IV push x1 now
Discontinue blood transfusion
Apply O2 to maintain SpO2 >92%

Answer 1

Subject: Update on Mr. Romaine's condition - ISBAR report

Introduction: This is [Your Name], the healthcare provider attending to Mr. Romaine, a [age] [gender] patient who was placed on supplemental oxygen due to respiratory distress. I wanted to update you regarding a potential problem that has arisen.

Situation: Currently, Mr. Romaine's oxygen supplementation is set at 2 LPM, which has improved his SpO2 to 92%. However, he is experiencing ongoing shortness of breath, with a respiratory rate of 22 breaths per minute. Upon auscultation, I observed clear lung sounds in the upper fields but detected fine crackles bilaterally in the bases. In addition, his skin feels cool and clammy.

Background: Mr. Romaine was initially placed on supplemental oxygen due to respiratory distress, and his SpO2 has improved with the current oxygen setting. However, his symptoms persist, indicating a potential issue that requires attention.

Assessment: Based on my assessment, Mr. Romaine's condition appears to be deteriorating, as evidenced by the presence of fine crackles in the lung bases, cool and clammy skin, and ongoing shortness of breath.

Recommendation: In light of the observed changes, I propose the following course of action:
1. Administer Furosemide 40 mg via IV push once, in order to address potential fluid accumulation contributing to Mr. Romaine's respiratory distress.
2. Discontinue the ongoing blood transfusion, as it may potentially exacerbate the respiratory compromise.
3. Apply sufficient oxygen to maintain a SpO2 level above 92%, in adherence to the provided oxygen saturation target.

I would appreciate your guidance and any further recommendations to manage Mr. Romaine's condition.

Thank you for your attention to this matter.

Sincerely,
[Your Name]