Question

75 y/o AAF presents with CHF, COPD, OSA, tracheal stenosis, s/p tracheostomy placed in 3/6/2013, of note this was the patient’s third tracheostomy.  The patient presented to the ED 2 weeks ago complaining of flu like symptoms.  Patient was found somnolent at home, slept all day with a large amount of secretions.  Patient’s daughter suctioned around 4 times at home, but home pulse ox was reading around 50-75%.  911 was called and EMS brought patient to the ED for SOB, respiratory distress, and a productive cough and placed patient on a 30% trach collar.

The following are vital signs and lab values:

Time (2315)
HR  75	Weight:  155 kg
RR 19	Height: 69 in.
BP  159/96
CXR:  bilateral scattered infiltrates	ABG on 30% oxygen: 7.20/89/40/15/-10/82%
Glucose 110
WBC 20
Hgb 8.6
Na 145
K 4.3
CO2 37
Cl 106
Cr 1.88
BUN  52

1.     What is the classification AND interpretation of the ABG given?

2.     Based on the lab values you are given in this scenario, what else can be wrong with the patient, if anything?

3.     What is the overall plan for the patient?

4.     Are there any additional tests for the patient?

5.     Specifically, what can you do for this patient as a respiratory therapy student?  Be specific.

Answer 1

1. Classification of Respiratory distress - Type 1 hypoxemia

ABG interpretation - metabolic acidosis

2. As the patient's creatinine and BUN is above normal so there are chances that the patient might have kidney disease or injury

3. Overall plan is to relieve the respiratory distress and assessment of the kidney functions .

4. Yes ,there are additional tests for the patient for assessing the kidney functions such as RFT , scans, GFR etc