Page 16 of 17

AS11.1-6 | Oxygen Therapy and Airway Management Foundations — Assignment

Instructions

1. Read the following patient scenario carefully:

A 72-year-old woman (weight 68 kg, estimated ideal body weight 58 kg) is admitted to the emergency department with community-acquired pneumonia. She is tachypnoeic at 28 breaths/min, confused (GCS 12), and her SpO₂ is 80% on room air. She has a history of COPD (FEV₁/FVC 0.58 on last spirometry). There is no history of trauma. Her vital signs: BP 95/60 mmHg, HR 118/min, temperature 38.9°C.

2. Write a structured clinical decision brief with the following clearly labelled sections:
a. Oxygenation Assessment — state the problem (type and severity of respiratory failure), your SpO₂ target range (with justification for COPD), and identify the oxygen delivery device you will use FIRST and why.
b. Oxygen Device Rationale — describe the device mechanism (fixed vs variable performance), the FiO₂ it delivers, and why this device is the correct match for this patient's physiology and risk profile.
c. Monitoring Plan — list the parameters you will monitor (SpO₂ target, ABG timing, work of breathing, consciousness level) and specify the thresholds that would prompt escalation.
d. Airway Escalation Plan — write a stepwise plan: (i) current basic manoeuvre if consciousness drops further, (ii) which adjunct you would use and why (OPA vs NPA — justify your choice given GCS 12), (iii) criteria that would trigger advanced airway management.
e. Mechanical Ventilation Initial Settings — if the patient fails non-invasive measures and requires intubation, specify: mode (volume-controlled vs pressure-controlled), FiO₂, PEEP, tidal volume (calculate using IBW), respiratory rate, and justify each setting with reference to her underlying COPD and ARDS-risk from pneumonia.

1. Use correct clinical values throughout — doses (mg/kg), FiO₂ ranges, flow rates, ventilator settings — citing Morgan & Mikhail's Clinical Anesthesiology or Ajay Yadav's Textbook of Anaesthesia where relevant.
2. Conclude with a one-paragraph summary of the single most important principle guiding your oxygen and airway decisions for this patient.

Length: 700–900 words (excluding headings and calculations)

Grading Rubric — Oxygen Therapy and Airway Management Foundations Assignment Rubric

Criterion	Points	Full-marks descriptor
Oxygenation Assessment and Device Selection: Correctly identifies type 1 vs type 2 respiratory failure; states appropriate SpO₂ target (88–92% for COPD); selects Venturi mask with correct FiO₂ adaptor; explains fixed-performance rationale	20 pts	Correctly classifies respiratory failure; SpO₂ target 88–92% with COPD justification; Venturi mask chosen with exact FiO₂ setting stated; mechanism of fixed performance vs variable performance devices explained accurately.
Airway Adjunct Decision: Correctly justifies NPA over OPA at GCS 12 (partial consciousness, likely intact gag reflex); states correct GCS threshold for definitive airway (≤8); lists correct indication criteria for advanced airway	20 pts	NPA correctly chosen for GCS 12 with intact-gag-reflex justification; definitive airway threshold stated as GCS ≤8; advanced airway criteria accurately listed (inability to oxygenate, ventilate, or protect airway).
Mechanical Ventilation Settings: Calculates tidal volume using IBW (not actual weight); states mode, FiO₂, PEEP, RR with values in acceptable lung-protective range; justifies each setting with reference to patient's physiology	20 pts	IBW used for VT calculation (6–8 mL/kg IBW); all five settings stated with plausible values; each justified by patient physiology (COPD, pneumonia, risk of ARDS); plateau pressure mentioned as monitoring target.
Clinical Accuracy of Values and Pharmacological Facts: All quoted FiO₂ ranges, flow rates, and ventilator parameters are accurate; no factual errors in device capabilities, ABG interpretation, or oxygen therapy principles	20 pts	All FiO₂ ranges, flow rates, and ventilator values accurate; ABG interpretation correct; no factual errors in oxygen therapy principles or device capabilities.
Clarity, Clinical Communication, and Synthesis: Brief is logically structured, readable, and integrates all elements into a coherent management plan; concluding paragraph correctly identifies the key governing principle	20 pts	All sections present with clear headings; information integrates seamlessly; concluding paragraph accurately identifies the governing principle (e.g., titrated oxygen to minimise CO₂ retention while preventing hypoxia); 700–900 word range met.