Question

A 68-year-old male is currently in the ED being seen for what appears to be an exacerbation of congestive heart failure. He is oriented to person, place, and time but is very anxious. Physical examination findings are as follows: pulse 129 beats/min and thready; blood pressure 108/64 mm Hg; temperature 37°C; respirations are 28 breaths/min, shallow, and labored, with accessory muscle use. Auscultation reveals bilateral decreased breath sounds with diffuse coarse crackles on inspiration. The patient has no cough and is diaphoretic. The RT places the patient on a nonrebreather mask and draws an arterial blood gas (ABG) after 15 minutes. The ABG shows pH 7.31, PaCO2 49 mm Hg, PaO2 53 mm Hg, SaO2 86%, and HCO3 2 23 mEq/L.

1. Does this patient meet the selection criteria for NIV? Why or why not?

2. If NIV is appropriate, what settings should be used? If not, what other respiratory therapy should be initiated? After 3 hours of treatment, the patient has become agitated, confused, and uncooperative.

3. What action should be taken at this time

Answer 1

Yes,patient meet the selection criteria because his Arterial blood gas reports is abnormal.he has low ph,high carbondioxide level,low oxygen and normal bicarbonate.this reports indicates he has acute respiratory acidosis.according to NIV criteria if patient has severe respiratory conditions she should be admitted in emergency department for to get immediate treatment

NIV is appropriate thus immediate care should be provided .Oxygen administration,pharamacological tnerapy should be provided immediately.cardiac monitor should be attached for contineous monitoring of vital signs,ECG,oxygen saturation.mechanical ventilator should be kept ready beside the patient for intubation on emergency.

Sedation can be used for NIV patients to avoid NIV failure if patient get agitated ,confused and un cooperative.but,increased use of sedation can be harmfull for patient as it increases hypercapnic state which can leads to the death of the patient.However,studies shows that sedation can be given for NIV patient with out severe complications in case patient is unccoperative.