MRCP2-3495

MRCP2-3495

As the medical registrar on-call, you receive a fast-bleep to attend to a patient in the resuscitation room of the Emergency Department. A 28-year-old woman has been admitted with severe breathing difficulties and hypoxia, and has become increasingly drowsy during her time in the department. The emergency physicians have performed arterial blood gases, which show:

pH 7.142
pCO2 12.5 kPa
pO2 9.19 kPa
HCO3 25.3 mmol/l

Due to the rapidity of her decline, the emergency physicians were only able to obtain a brief history before intubation was required. The patient reported a productive cough over the last few days and mentioned that she was taking tablets for a neurological condition.

Upon examination, you notice that the patient is intubated and maintained on sedation with propofol. She has a well-healed midline sternotomy scar, and coarse crackles are audible in the left mid and lower zones of her chest.

The patient is transferred to the Intensive Care Unit for continued mechanical ventilation and is started on empirical broad-spectrum antibiotics. What additional intervention would most hasten her recovery?