My Easter Sunday at work was unfortunately quite challeging. I came in to work that morning, had a patient that became lethargic and in respiratory distress even with bipap support. She was given a low dose of Ativan to help her relax and a 1 unit of PRBC 3 hrs ago per night shift. I assessed her lungs and heard rales and crackles, HR-125s. BP normal. O2sats were falling below 90s even with bipap support. I called the RT to help assess her respiratory status and check the bipap. Had the chance to talk talk to the hemodialysis nurse and made her aware on the patient case and patient may need an urgent hemodialysis. I called the Hospitalist and Nephrologist, and finally transferred the patient for hemodialysis room. O2 sats went up but she is still on Bipap support all shift. Patient and family has been informed that she will need to be in hospice or comfort measures, however patient does not want to give up her dialysis and she does not want surgery of her AVS.
Is there anything else we could have done differently on this patient with known severe AVS, recent AKI w/ placement of tunneled hemodialysis catheter and now with worsening respiratory distress and might be Bipap dependent??