How to Answer Edwina Brown Situation Questions (Complete Guide)

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Original Question

Edwina Brown D.O.B. 14.01.1978 URN 67232 Situation Edwina was admitted overnight to the intensive care unit. She was being treated 12 hrs ago for severe anaphylactic shock. Initially she was treated in the Emergency Department, where she suffered a cardiac arrest, but was successfully resuscitated. Her anaphylactic shock was treated initially with adrenaline, intravenous fluid and corticosteroids. Her oxygen saturations are low despite having high flow oxygen Her blood pressure initially improved, the urticaric rash has resolved and the acute respiratory wheeze resolved. However over the past three hours, Edwina’s blood pressure has fallen again. Her urine output has fallen. Her lactate level has risen to 4.5mmol/l She has been administered 1 litre of Normal Saline intravenously over 1 hour. There are NO signs of ongoing anaphylaxis Observations A – patent – but at risk due to GCS B – RR26bpm, SaO2 86% on 15l/min Oyxgen C – HR112bpm, BP 80/65mmHg, Hourly urine output 25 mls. D – GCS = 8 (E1, V3, M4) – BSL E – Temp 36.5.0 deg C Arterial Blood gas: pH: 7.25 pO2: 75mmHg pCO2: 45mmHg Bicarb : 18mmHg Base excess: -4 Background Edwina is a student physiotherapist in her final year of university. She lives with her parents. She is known to be allergic to bees and usually carries two epipens. Agreed plan Current treatment: On highflown oxygen – 15l/min oxygen via non-rebreather mask 1 litre normal saline administered IV over past hour Indwelling urinary catheter in situ Attached to cardiac monitor Read back / questions None Pathophysiology Explain what multiorgan dysfunction syndrome (MODS) is and how a nurse might recognise it in their patient. Discuss why this condition can be difficult to manage. How common is the condition? Has the condition become more common following the outbreak of COVID 19? If so, why might this be? Edwina cannot sustain oxygenating her organs unassisted. What measures can be take to address this?

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