Question

The patient is a 60-year-old Caucasian female presenting to the emergency department with acute onset shortness of breath. Symptoms began approximately 2 days before and had progressively worsened with no associated, aggravating, or relieving factors noted. She had similar symptoms approximately 1 year ago requiring hospitalization. She uses BiPAP ventilatory support at night when sleeping. She denies fever, chills, cough, wheezing, and sputum production but does get short of breath easily. There are no known ill contacts at home. Her family history includes significant heart disease and prostate malignancy in her father. Social history is positive for smoking tobacco use at 30 pack years. She quit smoking 2 years ago due to increasing shortness of breath. She denies all alcohol and illegal drug use. There are no known foods, drugs, or environmental allergies. Physical Exam Initial physical exam reveals temperature 97.3 F. heart rate 74 bpm. respiratory rate 24. BP 104/54, BMI 40.2, and O2 saturation 90% on room air. Pulmonary/Chest: No respiratory status distress at this time, tachypnea present.() wheezing noted. bilateral rhonchi, decreased air movement bilaterally. Patient barely able to finish a full sentence due to shortness of breath ABG: Initial arterial blood gas with pH 7491. PCO2 27.6, PO2 53.6, HCO3 20.6, and oxygen saturation 90% on room air. 1. What is your interpretation of the ABG results? 2. Based on the findings, what is the clinical diagnosis? 3. What medication would you anticipate the health care provider ordering? 4. What is the difference between Bipap and CPAP?

subject: medical Surgical.

Answer 1

1. Interpretation of ABG result

Ph is 7.491 (normal range 7.35-7.45) increased

PCO2 27.6(35-45mm of hg)decreased

PAO2-53.6(85-100mm of hg)decresed

HCO3 20.6(23-30meq)decreased

Here PH incresed,PCO2 and PAO2 and HCO3decresed.so respiratory alkalosis with renal compensation.

2. Clinical diagnosis is COPD(Chronic Obstructive pulmonary disease)

Here patient had history of smoking which is one of risk factor of COPD and triggered at night.The device used for COPD is BIPAP. Hyperventillation is one of clinical feature.

3.Medication

• Bronchodialators and steroids
• Brochodialators inhaled eg:Albuterol(6-8puff daily)
• Steroid eg:prednisone 40mg Od for 5days.
• Antibiotics :Amoxicylline 1gm for 3days, levofloxacin 500mg od.
• Aminophyllin if exacerbate.
• Dexona 4mg intravenously
• Derphyllin intravenously

4. CPAP (continuous positive airway pressure)

• Same pressure is delivered during inhalation and exhalation
• It is cheaper.
• Need little monitoring.

BIPAP(Biphasis positive airway pressure)

• Different pressure delivered during inhalation and exhalation.
• Expensive
• Needs monitoring
• Used in COPD patient