Question

1. A 26-year-old male with a history of opiod abuse arrives unconscious, and unresponsive, in the emergency department via EMS. He is suspected of taking an overdose of an unknown substance. The patient was found in a collapsed state in his apartment by a friend. His friend believes that the patient may consumed pain medications in addition to an unknown quantity of of alcohol. His vital signs include tachycardia (HR=140), irregular pulse, bradypnea (f=8), and decreased blood pressure (90/60 mmHg). Breath sounds are diminished. An arterial blood gas sample taken on oxygen by partial re-breathing mask reveals:pH = 7.18, Paco2 = 70 mmHg, HCO3 = 28 mmHg, Base Excess (BE) = 1.0, PaO2 = 90 mmHg, SaO2 = .96 mmHg. Based on this information, how would you describe this patient's oxygenation and ventilatory status?Is mechanical ventilatory support indicated for this patient? Why or why not?
2. A 24 year old female patient is admitted to the hospital with severe bilateral pneumonia. The patient is awake and alert, but in severe distress. Blood gasses on a partial re-breathing mask at 10L/min are as follows:pH = 7.52, Paco2= 28 mmHg, Pao2 = 48mmHg, Respiratory Rate = 28 breaths/min, HCO3 = 23mEq/L, BE = 2, SaO2 = .89,Heart rate = 118. What is your assessment of this patient?Is mechanical ventilation indicated for this patient? If so why? If no, why not?

Answer 1

answer

1. in this question , the patient is opipod abuse(causes repiratory depression) and unconsious and unresponsive , moreover his vitals like bp 90/60 , lower , repiratory rate is low , 8 ( normal rate is 12 to 20 per minute). diminished breath sounds , tachychardia, irregular pulse ,

his arterial blood gas values also shows abmormality

ph = 7.18 , acidosis . (normal  blood ph is 7.35 to 7.45 ) if value less than 7.35, is acidic. values more than 7.45 is alkali

paco2 is 70 mmhg , which is high (normal paco2 is 38 to 42 mmhg) , due to decreased respiratory rate , body is not able to expire the co2 produced in tissues, which leads to respiratory acidosis ,

here HCO3 level is 28 which is within in upper normal limits (norml 22 to 28 meq /l  ) . for the neutralization of effects of high co2 in blood , more HCO3 is produced.

here , patients pa02 is 90 mmhg . which is within normal limits (normal is 80 to 100 mmhg) , and sa02 is 96 mmhg , which is normal (normal 94 to 100%) . so patients oxygenatioin is maintained, which is the process of delivering 02 from alveoli to tissues in order to maintain cellular activity ,

ventilation is the process of delivering oxygen rich air to the alveoli from atmosphere, which depond up on volume of air and respiratory  rate. here respiratory rate is low , hence ventiltion also low in this patient. , along with correctionm of acid base disturbances

this patient requires mechanical ventilation , as he is unconsious , he is having respiratory acidosis , low respiratory rate

2. this patient is having bilateral pneumonia, consious ,alert

her respiratory rate is 28 , which is high ,which wash out all co2 , leads to low level of paco2 (here, 28 mmhg ),

her bloo ph is high (7.52) , due to respiratory alkallosis. and HCO3 Level is within lower limit , to reduce the alkaly effect in blood (compensation made by kidney). her pao2 is also low (48 mmhg) ,her sao2 also low(89%) these means tissues are not getting enough oxygen for metabolism.

this patient also need mechanical ventilation , as her blood oxygen parameter are not normal .even though she is alert, because of bilateral pneumonia , she need ventilation support