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All Journal International Journal of Health, Engineering and Technology
Rois Hasyim
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Agriculture, Biological Sciences & Forestry Chemical Engineering, Chemistry & Bioengineering Dentistry Engineering Health Professions Immunology & microbiology Industrial & Manufacturing Engineering Mechanical Engineering Medicine & Pharmacology Nursing Public Health Veterinary

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Near-Fatal Asthma With Severe Hypercapnic Respiratory Failure Requiring Mechanical Ventilation In A Resource-Limited Setting: A Case Report Sinta Triagustina; Delta Iswara; Anggita Dian Karera; Rois Hasyim; Rachmad Aji Saksana
International Journal of Health Engineering and Technology Vol. 5 No. 1 (2026): IJHET MAY 2026
Publisher : CV. AFDIFAL MAJU BERKAH

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55227/ijhet.v5i1.734

Abstract

Near-fatal asthma (NFA) is a life-threatening manifestation of acute severe asthma characterized by hypercapnia, respiratory acidosis, altered consciousness, and the need for invasive mechanical ventilation. Early recognition and timely airway stabilization are essential to prevent respiratory arrest and mortality, particularly in resource-limited settings. A 41-year-old woman with a history of asthma was brought to the emergency department with decreased consciousness and severe respiratory distress. On arrival, her Glasgow Coma Scale score was 5, respiratory rate was 35 breaths per minute, and oxygen saturation was 46% on room air. Arterial blood gas analysis demonstrated life-threatening hypercapnic respiratory failure (pH 6.954; PaCO₂ 95.4 mmHg; P/F ratio 87). Due to worsening respiratory failure and decreased level of consciousness, the patient underwent immediate endotracheal intubation and invasive mechanical ventilation and was admitted to the intensive care unit. She received systemic corticosteroids, repeated bronchodilator therapy, aminophylline infusion, and broad-spectrum antibiotics. Lung-protective ventilatory strategies with prolonged expiratory time were applied. The patient improved rapidly and was successfully extubated on the second day of mechanical ventilation, with subsequent discharge in stable condition. Appropriate ventilatory strategies combined with guideline-based pharmacological therapy are essential to improve outcomes in patients with near-fatal asthma presenting with severe hypercapnic respiratory failure, even in resource-limited settings.
Moderate Hyperkalemia Presenting As Sinus Arrest With Junctional Escape Rhythm From A Hospital With Resources Limited Setting: A Case Report And Narrative Review Delta Iswara; Anggita Dian Karera; Satrya Yudha Dwi Putranto; Rois Hasyim
International Journal of Health Engineering and Technology Vol. 5 No. 2 (2026): Vol 5. No. 2 JULY 2026
Publisher : CV. AFDIFAL MAJU BERKAH

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55227/ijhet.v5i2.1073

Abstract

Hyperkalemia is a potentially life-threatening electrolyte disturbance that can cause severe cardiac conduction abnormalities, even at moderate serum potassium levels, particularly in elderly patients with underlying cardiovascular disease. Management of acute hyperkalemia remains challenging, especially in resource-limited healthcare settings where advanced therapies such as urgent dialysis may not be readily available. We report a 77-year-old woman who presented with generalized weakness and recurrent syncope. Electrocardiography revealed sinus arrest with a junctional escape rhythm, and laboratory evaluation showed moderate hyperkalemia (6.84 mmol/L) accompanied by acute kidney injury, anemia, and mild metabolic acidosis. The patient had a history of anterior ST-elevation myocardial infarction and was receiving potassium-retaining medications. She was admitted to the intensive care unit and treated with protocol-based glucose–insulin therapy, intravenous calcium gluconate, adjunctive β-adrenergic agonists, and supportive care, without immediate access to dialysis. Serial ECGs demonstrated recovery of sinus rhythm, and serum potassium levels gradually normalized. This case illustrates that moderate hyperkalemia can precipitate severe bradyarrhythmias such as sinus arrest. Early recognition of ECG changes and prompt, protocol-driven management can result in favorable outcomes, even in resource-limited settings without immediate dialysis availability.
Co-Authors Anggita Dian Karera Anggita Dian Karera Delta Iswara Delta Iswara Rachmad Aji Saksana Satrya Yudha Dwi Putranto Sinta Triagustina