Question

A patient with a hx of 50 pack year smoking history presents with a barrel chest, flattened diaphragms on CXR.  In ED, patient is purse lip breathing.  He has had a recent upper respiratory infection and is now congested with SOB.

ABG on RA: 7.32/65/42/31/75%

A.     Classify the ABG

B.     List abnormal manifestation

C.     Interpret (what diseases, pathology or pathophysiology could lead to the patient’s condition?)

D.    Make specific recommendations for treatment

Answer 1

A patient presents with a barrel chest and flattened diaphragms on CXR.

The patient's chest x-ray and symptoms show he has emphysema.

A. ABG -

PH - 7.32 (Is in acidic range)

ABG indicates Respiratory Acidosis because pH is in the acidic range and its caused by high PCO2.

B.

PCO2 - 65 (is in the high range, Reason for acidosis)

PO2 - 42 (Very low due to ineffective respiration)

HC03 - 31 (Is in the high range, its actually compensating sue to high pH)

SO2 75% (Very low due to ineffective oxygenation)

C.

It is a clear case of emphysema.

There is carbon dioxide retention due to ineffective breathing which increases the level of PCO2 in the blood. Increased PCO2 makes blood acidic which is the reason for Acidosis.

Alveoli of the lungs are damaged in emphysema., which severely affects gaseous exchange in the lungs. This case PO2 level is very low due to impaired gaseous exchange which causes a low saturation level.

D.

Bronchodilators - It dilates the airways and reduces dyspnea which facilitates carbon dioxide wash out.

Steroid - It reduces inflamation

Antibiotics

Postive pressure ventilation.