ICU Knowledge Map

R3Mixed Problems & Reassessment

Initial Presentation

Severe ARDS Ventilator Strategy

A 52-year-old woman (height 165 cm; PBW about 57 kg) with severe viral pneumonia was intubated yesterday and is deeply sedated.

98/min

115/70 mmHg

SpO2

88%

Temp

38.5°C

Bilateral opacities consistent with ARDS after exclusion of a dominant hydrostatic cause.
VC-AC: Vt 480 mL (about 8.4 mL/kg PBW), RR 20/min, PEEP 10 cmH2O, FiO2 0.70.
ABG: pH 7.32, PaCO2 48 mmHg, PaO2 55 mmHg; P/F ratio about 79.
Inspiratory hold: Pplat 35 cmH2O; driving pressure about 25 cmH2O (Pplat − total PEEP if no significant auto-PEEP).

Problem framing → competing data → treatment → response → second-order decision

1. Problem framing2. Data integration3. Therapeutic decision4. Reassessment5. Second-order problem

Mixed physiology, ABG/hemodynamic/renal/ventilator integration, reassessment.

Learning objectives are intentionally hidden before the case. Commit to a working diagnosis and priority before seeing the full debrief.