Clinical Scenario

C was a 47 year old woman with Down syndrome. She had a VSD, pulmonary hypertension and Eisenmenger syndrome. She was taken to ED by her family with a productive cough, diarrhoea, vomiting and fever. Oxygen saturations were found to be 61% on air. C is needle phobic and doesnt communicate with words.

C was given oxygen via face mask. Sedation was considered to allow her to have blood taken, but the decision was made not to proceed with this due to the level of risk. Cs heart rate, blood pressure and oxygen saturations were monitored and a chest x-ray was carried out. This was interpreted as inconclusive. Cs auscultation findings suggested a lower respiratory tract infection so oral antibiotics were started. Oxygen was titrated down and after a while Cs saturations were 75% at rest on air, which was normal for her, according to old notes.