A 60 year old male, known case of morbid obesity with obstructive sleep apnoea presented with complains of increasing breathlessness for 2 days. He was afebrile, drowsy and dyspnoeic, BMI was 44 Kg/m² (Obesity class III) with heart rate 116/min, blood pressure 170/90 mmhg, SpO₂ 64% on room air and Respiratory rate 26-30/min. On auscultation heart sounds were normal and bilateral air entry was decreased in lungs with presence of wheeze. Arterial blood gas was suggestive of type II respiratory failure with severe respiratory acidosis. Initially BIPAP was applied. However, the patient subsequently developed bradycardia. He was intubated and revived by Cardiopulmonary resuscitation as per ACLS protocol. Post resuscitation he was haemodynamically stable with GCS E₂V_TM₃.

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Dr Anant Vikram Pachisia