80F Sudden breathlessness after bedridden 10 days after femur fracture 1 mth Telangana PaJR

 

21-01-2026

THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HER SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY EXPERTS WITH AN AIM TO SOLVE THOSE PATIENT'S CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUTS.

[10.41 am, 21/01/2026] PPM 1: EMR CDSS (conversational decision support system) notes in a human agentic workflow between hu1 and hu2 human user 1 and 2:

[19/01, 21:40] Hu1 2023: Her RR is 24 to 28  

taking breath with accessory muscle usage

[19/01, 21:41] Hu1 2023: does she requires reintubation 

[19/01, 21:49]hu2: Not unless she develops fatigue and hypoventilation suggested by hypercapnia

[19/01, 21:49] Hu1 2023: She is going into distress

[19/01, 21:49] Hu1 2023: in between she is awakened 

[19/01, 21:50] Hu1 2023: Post extubation chest xray

[19/01, 21:50] Hu1 2023: This is after 2 hrs extubation

[19/01, 21:50] Hu1 2023: under room air  

[19/01, 21:51] Hu1 2023: Auscultation she is having laryngeal stridor, some wheeze in anterior chest

[19/01, 21:52] Hu1 2023: Abg now

[19/01, 21:52]hu2: Looks like severe hypoxia possibly due to air still escaping from the tracheal perforation? Can you share the initial history with me as I have forgotten from Saturday

[19/01, 21:53]hu2: BP stable? Creatinine? Is the metabolic acidosis due to increased lactate?

[19/01, 21:55] Hu1 2023: Bp heart rate stable sir

[19/01, 21:57] Hu1 2023: This is room air no sir, may be bcz of that hypoxia?

[19/01, 21:58] Hu1 2023: Her investigation chart

[19/01, 22:01] Hu1 2023: What to do now?

[19/01, 22:01] Hu1 2023: will re intubate her?

[19/01, 22:02]hu2: Currently her ABG PaO2 on O2 (how much fiO2?) is already very high!

[19/01, 22:02]hu2: Not for hypoxia which is already being controlled with Fio2. Please mention the FiO2

[19/01, 22:02] Hu1 2023: This is now. She is on O2 10 lit with hudson mask

[19/01, 22:03]hu2: Yes and it's too much oxygen fio2 as per the ABG paO2

[19/01, 22:03] Hu1 2023: Yes sir there is no hypoxia it seems

[19/01, 22:03]hu2: Then what's the current need for intubation?

[19/01, 22:04]hu2: She's not hypoventilating either

[19/01, 22:04]hu2: We need to reduce the FiO2 to prevent oxygen toxicity

[19/01, 22:05] Hu1 2023: I'm in dilemma 

[19/01, 22:05] Hu1 2023: Weather to intubate or not?

[19/01, 22:06] Hu1 2023: With that stridor, is she having laryngeal or tracheal edema 

Which is causing her respiratory distress??

[19/01, 22:07] Hu1 2023: If tracheal perforation is leaking that subcutaneous emphysema should spread 

[19/01, 22:08] Hu1 2023: Case extubated at 3 30 pm today. It's almost 6 hrs now

[19/01, 22:09]hu2: Has it spread?

[19/01, 22:09] Hu1 2023: No 

[19/01, 22:10]hu2: The video sound suggests a wheeze.

What are the current auscultation findings?

[19/01, 22:11] Hu1 2023: laryngeal stridor, anterior wheeze mild. Left isa decreased breath sounds

[19/01, 22:13]hu2: Have we tried nebulization?

[19/01, 22:13] Hu1 2023: Yes 

[19/01, 22:14] Hu1 2023: after nebs it's coming down and after some time developing again

[19/01, 22:14]hu2: That means there is a bronchoconstriction

What medications were given in the nebulizer?

[19/01, 22:15] Hu1 2023: Budecort

[19/01, 22:15] Hu1 2023: Duolin

[19/01, 22:15] Hu1 2023: Shall I try adrenaline nebs 

[19/01, 22:16] Hu1 2023: Iv hydrocort also given 

[19/01, 22:21]hu2: Repeat the budecort again

https://pmc.ncbi.nlm.nih.gov/articles/PMC1793858/?page=2

[19/01, 22:21] Hu1 2023: Is this is stridor or wheeze?

[19/01, 22:25]hu2: Stridor

[19/01, 22:26]hu2: Can reintubate her.

Check out this case of post extubation stridor 👇

https://pmc.ncbi.nlm.nih.gov/articles/PMC9918331/#:~:text=Endotracheal%20intubation%20is%20a%20lifesaving%20procedure%20frequently,and%20severe%20stridor%20leading%20to%20subsequent%20reintubation.

[19/01, 22:26] Hu1 2023: Seems Ent opinion taken 

they may plan for tracheostomy 🥺

[19/01, 22:27]hu2: Yes can. Will be better as reintubation could be difficult. Can get anesthesia help if contemplating reintubation.

                   
                                                          

[10.47 am, 21/01/2026] PPM 1: https://youtube.com/shorts/roDuNreaJhk?si=tWrW1RKRlrPfQEfZ

https://youtu.be/chPG9PkaU9g?si=HzurW0Ch6yHlFaQV
[4.08 pm, 21/01/2026] PPM 1: https://youtube.com/shorts/PooBZvH9-dw?si=JfkA-knx9B-4FK86
CT brain video of the patient. 👆