Is That Inappropriate??

I have the "pleasure" of doing night shifts again. This is my first on call as the leader for the hospital at night team....which actually, scares me, ALOT.

Anyway, over the past 2 nights, I have been in contact with ITU.

Now, my understanding is, contact ITU if you think a patient may need ventilatory support.

And now, what would you do for the following:



Situation 1

A young middle aged lady, with severe COPD and morbid obesity, was admitted with exacerbation of her COPD. She took 2 of her sleeping tablets before coming to the hospital. She was mainitaining her own airway, but was very drowsy. When she falls asleep, her respiratory rate went up and she developed marked wheeze.



Situation 2


A young man with known asthma, was found with respiratory depression. He denied taking any illicit drugs on that day, but did admit that he is a drug abuser. He has a GCS of 14, and his respiratory rate was only 8. Oxygen saturation was 95% on 12L oxygen. He was also in respiratory acidosis.



Now, my impression of the above is they are both fairly sick...and may lose their ability to maintatin their own airway, if they drop their GCS. Therefore, I contacted ITU to keep them informed. However, I was told by the ITU doctor that these referrals were inappropriate?

She even told me off over the telephone. sigh. She was not interested. Well, at least, I have done my bit to provide medical care....