A 40-year-old gentleman with no past medical history of note presents to the Emergency Department with increasing shortness of breath, productive cough, fever and pleuritic right sided chest pain for 7 days.
On assessment he is noted to be tachycardic (heart rate 110 bpm), tachypnoeic (respiratory rate 30 breaths/minutes), febrile (temperature 38.0oC), SpO2 of 85% on 15L/min O2 using a non-rebreathe mask and a PaO2 of 8.0 kPa. Chest auscultation reveals right sided basal coarse crackles. A plain erect CXR demonstrates right middle and lower lobe consolidation. A decision is made to admit him to the High Dependency Unit initially for High Flow Oxygen.
48 hours later, his oxygen requirements have continued to increase with a PaO2 of 7.0 on 70L/min (high flow nasal cannula) and an FiO2 of 1.0. The patient looks tired and a decision to intubate and ventilate is made.
A post intubation CXR shows progression with opacification in all four lung quadrants.