| Course | NU657 AGACNP Critical Care Management Clinical |
|---|---|
| Unit | Unit 9 |
| Paper type | Case conference presentation |
| Length | About 1,150 words, 7 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NU657 Unit 9
A Tongue That Would Not Fit: A Case Conference Presentation on ACE Inhibitor Angioedema, Awake Fiberoptic Intubation and Whether Icatibant Belongs in the Plan
[Student Name]
Purdue University Global
NU657: AGACNP Critical Care Management Clinical
Unit 9 Case Conference Presentation
[Instructor Name]
[Date]
The patient is composite; values, doses and times are bracketed. Slide text is followed by speaker notes.
Slide 1: The Case and the Question
Slide text: [58]-year-old woman, lisinopril [20] mg for [four] years. Woke at [05:10] with a swollen tongue and lower lip. No hives, no itching. Question for the conference: bradykinin blockade or not, and does it change the airway plan?
Speaker notes: This presentation is built around one decision. I will show what we did on each day, and then ask you to weigh two trials that point in different directions.
Slide 2: Arrival
Slide text: [06:20] emergency department. Tongue enlarged and protruding past the teeth, floor of mouth firm, voice muffled, drooling. No stridor at rest. Saturation [97] percent on room air. Pressure [152/88], no urticaria, no wheeze.
Speaker notes: The absence of hives and itching, and four years on an ACE inhibitor, point away from an allergic reaction and toward bradykinin. That distinction matters because epinephrine, antihistamines and steroids treat histamine, not bradykinin. They were given anyway in the first minutes, which is reasonable when the type is uncertain, but they did not help, and nobody expected them to.
Slide 3: Why Her
Slide text: ACE inhibitors block the breakdown of bradykinin. Angioedema can appear after years of use. Risk is higher in Black patients.
Speaker notes: She is Black, and in a Tennessee Medicaid cohort of ACE inhibitor users, Black patients had an adjusted relative risk of angioedema of 4.5 compared with white patients; the same study found the risk highest in the first month of use but present for years afterward (Brown et al., 1996). The reaction was not a new allergy but a known effect of the drug, which is why patients and clinicians often do not connect it to a medicine taken for years.
Slide 4: The Airway Decision
Slide text: Tongue and floor of mouth involved. Voice changing. Swelling still increasing at [07:00]. Decision: awake fiberoptic nasal intubation in the operating room, surgical airway team scrubbed.
Speaker notes: Swelling of the tongue and floor of the mouth, with a change in voice, is the pattern most often linked to needing an airway. With the tongue filling the mouth, the safest airway is the one placed while she is still breathing on her own, with a surgeon ready. Paralysis and direct laryngoscopy could have left us unable to see or ventilate. She was intubated through the nose at [07:45] with a [6.5] tube on the first pass, and the surgeons were not needed.
Slide 5: The Drug Question, Day One
Slide text: Icatibant, a bradykinin B2 receptor blocker, is approved for hereditary angioedema. Should it be given here?
Speaker notes: This is the question I want the room to discuss. We did not give icatibant. The swelling had already declared itself, the airway was secured, and our pharmacy had the drug only through a request to the allergy team. I will show you the two trials that shaped our decision.
Slide 6: Evidence For
Slide text: Baş et al. (2015): [27] patients, randomized. Median time to complete resolution: [8.0] hours with icatibant versus [27.1] hours with steroid and antihistamine.
Speaker notes: This trial found a large effect. Complete resolution came more than three times sooner with icatibant (Baş et al., 2015). But it was a small, phase 2 trial, and the comparison was with drugs that do not work in bradykinin angioedema, so it compares icatibant with what is in effect no treatment.
Slide 7: Evidence Against
Slide text: Sinert et al. (2017): [121] patients, randomized, placebo-controlled. No difference in time to discharge criteria; median [4.0] hours in both groups.
Speaker notes: The larger trial found no benefit over placebo, either in time to discharge criteria or in the onset of symptom relief, and its subgroups showed the same result (Sinert et al., 2017). Most patients in both groups improved quickly, which suggests that many cases resolve on their own once the ACE inhibitor is stopped. When the larger, placebo-controlled trial is negative, a smaller positive trial is not enough to change practice on its own.
Slide 8: Day One in the ICU
Slide text: Sedated on propofol, ventilated. Lisinopril stopped and listed as an allergy with the reaction. Head of bed raised. Leak around the tube checked every [eight] hours.
Speaker notes: The management is mostly waiting. We measured the cuff leak regularly, as the swelling usually improves over one to three days. Sedation was kept light enough for daily neurologic checks but deep enough that she would not bite on or dislodge a nasal tube in a mouth still crowded by her tongue. Her pressure settled without treatment once the stress of the first hours had passed, and we did not restart any antihypertensive until the airway was out. The nurses recorded the tongue's position against her teeth at each shift change, which gave us a simple visual trend alongside the leak.
Slide 9: Day Two
Slide text: Tongue visibly smaller. Cuff leak [18] percent of tidal volume at [16:00]. Direct view of the pharynx: swelling improving.
Speaker notes: At this point we started planning extubation, with the anesthesia team available and a difficult airway cart at the bedside.
Slide 10: Day Three
Slide text: Extubated at [09:30] after a leak test and a fiberoptic look. No stridor. Transferred to the ward at [18:00].
Speaker notes: She was extubated uneventfully. Her voice was normal by the evening.
Slide 11: Her Blood Pressure After Discharge
Slide text: Lisinopril stopped permanently. Amlodipine started. Angiotensin receptor blockers avoided for now.
Speaker notes: A meta-analysis of patients who had angioedema on an ACE inhibitor found the risk of a later angioedema on an angiotensin receptor blocker to be between about [3.5] percent for confirmed cases and [9.4] percent for possible cases (Haymore et al., 2008). The risk is not zero, and her blood pressure could be managed well with a calcium channel blocker, so we chose amlodipine.
Slide 12: Discussion
Slide text: Would you give icatibant to the next patient, and if so, before or after the airway is secured? What would you need to see in a new trial?
Speaker notes: My own view is that icatibant should not delay a secured airway in a patient with a swollen tongue and a changing voice, whatever its effect on resolution. The drug might have a place in a patient whose airway is not yet threatened, but the best trial we have does not support routine use. I would like to hear whether any of you have used it and what you saw.
References
Baş, M., Greve, J., Stelter, K., Havel, M., Strassen, U., Rotter, N., Veit, J., Schossow, B., Hapfelmeier, A., Kehl, V., Kojda, G., & Hoffmann, T. K. (2015). A randomized trial of icatibant in ACE-inhibitor-induced angioedema. New England Journal of Medicine, 372(5), 418-425. https://doi.org/10.1056/NEJMoa1312524
Brown, N. J., Ray, W. A., Snowden, M., & Griffin, M. R. (1996). Black Americans have an increased rate of angiotensin converting enzyme inhibitor-associated angioedema. Clinical Pharmacology & Therapeutics, 60(1), 8-13. https://doi.org/10.1016/S0009-9236(96)90161-7
Haymore, B. R., Yoon, J., Mikita, C. P., Klote, M. M., & DeZee, K. J. (2008). Risk of angioedema with angiotensin receptor blockers in patients with prior angioedema associated with angiotensin-converting enzyme inhibitors: A meta-analysis. Annals of Allergy, Asthma & Immunology, 101(5), 495-499. https://doi.org/10.1016/S1081-1206(10)60288-8
Sinert, R., Levy, P., Bernstein, J. A., Body, R., Sivilotti, M. L. A., Moellman, J., Schranz, J., Baptista, J., Kimura, A., & Nothaft, W. (2017). Randomized trial of icatibant for angiotensin-converting enzyme inhibitor-induced upper airway angioedema. The Journal of Allergy and Clinical Immunology: In Practice, 5(5), 1402-1409. https://doi.org/10.1016/j.jaip.2017.03.003
NU657 Unit 9 instructions, in plain terms
The Unit 9 case conference asks you to present an ICU patient to an audience of clinicians and lead a discussion. Most prompts want about 12 to 16 slides with speaker notes, or a written equivalent, organized around a clinical question rather than a day-by-day chronology. The presentation usually covers the case, the key decisions and the evidence behind them, and ends with discussion questions. The grader is looking for a presenter who can weigh conflicting evidence and take a position while inviting disagreement. Citations belong in the notes and on the slides where a finding is shown, and each slide should carry a single idea. A patient from your own rotation, fully de-identified, is often expected.
How this NU657 Unit 9 example is built
Slide 1 states the case in two lines and the question. Slides 2 and 3 cover the arrival and the reasons she was at risk, citing Brown's Tennessee cohort for the relative risk in Black patients. Slide 4 explains the choice of awake fiberoptic intubation, with a highlighted sentence on why. Slide 5 restates the drug question. Slides 6 and 7 set the two icatibant trials side by side, with their sizes, comparisons and results, and a second highlighted sentence explains how to weigh them. Slides 8 to 10 cover the three ICU days, the cuff leak and extubation. Slide 11 handles her blood pressure after discharge, and slide 12 poses two questions and the presenter's own view.
Where the points sit in the NU657 Unit 9 rubric
Rubric rows for a case conference usually include organization around a question, clinical content, appraisal of evidence, delivery materials and facilitation of discussion. Organization earns full points when every slide serves the opening question. Clinical content is judged on accuracy and on explaining decisions, not just listing them. The appraisal row rewards presenting studies with their size, design and comparison group, and weighing them honestly when they disagree. Delivery materials are scored on slides with one idea each and notes that carry the detail. Facilitation points go to discussion questions that are open, specific and tied to the evidence shown, together with a stated position from the presenter.
NU657 Unit 9 help: mistakes that cost points
A frequent error is presenting the case as a daily log, which leaves the audience without a reason to follow it. Another is citing only the positive trial and ignoring the larger negative one. Students sometimes treat ACE inhibitor angioedema like anaphylaxis and expect epinephrine and steroids to work. Some slides crowd a full paragraph onto the screen instead of keeping detail in the notes. Others close on a recap slide, so the room has nothing to discuss. And switching the patient to an angiotensin receptor blocker without mentioning the small recurrence risk is a common gap in the discharge plan that the audience will likely raise.
Get an NU657 Unit 9 example written to your instructions
For the NU657 Unit 9 conference, pass along the case outline, how many slides or minutes you are given, and the rubric; mention whether the format is live, recorded or written. The model arrives in 24-48h, a first request costing nothing, built around one question, with each day's slide showing a decision and both sides of the discussion sourced. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
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NU657 Unit 9 questions, answered
How is a case conference different from a case study?
A case study is usually written for a grader and covers an admission thoroughly. A case conference is presented to clinicians and succeeds when it teaches them something, which usually means organizing the case around a question and ending in discussion. The sample does that, keeping day-by-day detail to one slide each and reserving time for the room.
Can the conference present a patient from my ICU rotation?
Programs often ask for exactly that, de-identified, with the choice of patient left to the presenter. The sample's woman is a composite with bracketed values. Your rotation hours, the encounters themselves and whatever faculty or preceptors write about your presentation are recorded by them and by you, never by a sample.
Where can I find a free NU657 Unit 9 sample paper?
This page shows the full NU657 Unit 9 case conference presentation, twelve slides with speaker notes covering the airway, the icatibant evidence, the ICU days and the discharge plan, plus four references. A presentation for your own ICU patient can be requested.
What do the icatibant trials in NU657 Unit 9 show?
A small 2015 trial of 27 patients found complete resolution in a median of 8 hours with icatibant versus 27 hours with steroid and antihistamine. A larger 2017 placebo-controlled trial of 121 patients found no difference in time to discharge criteria.
Why was amlodipine chosen in the NU657 Unit 9 case?
A meta-analysis found that patients who had angioedema on an ACE inhibitor carried a risk of later angioedema on an angiotensin receptor blocker of about 3.5 percent for confirmed cases. A calcium channel blocker avoided that risk while controlling her pressure.