Question

A 52 year old woman weighing about 110 pounds) was admitted to the hospital for thrombophlebitis in her left leg. Her hospital course was uneventful until the second day, when she had an acute episode of shortness of breath and pain in the left chest. The patient had no previous history of cardiopulmonary disease. Her physical examination revealed bilateral expiratory wheezing and a tender, non-inflamed left calf. The chest radiograph was unremarkable. Vital signs were measured and an arterial blood gas sample was drawn. The results are shown in table 1 under sample 1. The patient was given 40% oxygen from a high flow system via face mask. Twenty minutes later, another arterial blood sample was drawn and the vital signs were measured. The results are shown in Table 1 under Sample 2. pH Paco PaO2 HCO3 BE Sample 1 (0945) FiO, 21% 7.46 34 51 Sample 2 (1005) FiO40% 7.43 37 81 24 23 SaO2 BP 87% 130/90 120 99.6 0 95% 120/70 110 99.4 HR Temperature (F) RR 30 25 500 V1 (ml) MVe (L/min) 575 14.4 15.0 Assessment 1. Classify the blood gas in Sample 1 2. How does the actual Paco, in Sample 1 compare with what might be expected from the patient's minute ventilation? 3. What are the possible causes of the arterial hypoxemia of Sample 1? 4. Classify the blood gas in Sample 2 Intervention 1. What is the probable diagnosis? 2. How could it be confirmed? 3. Make specific recommendations for treatment

Answer 1

Assessment:

1. The sample 1 shows the patient has MILD HYPOXIA as the patient value is 51( paO2 40- 60mm Hg) where patient experience hypértension as the body tries to pump blood to vital organ to meet the O2 need so , as per scenario its observed BP 130/ 90mm hg and pulse of 120 b/ mt.and the reports shows the pH increased and pCO2 decreased which point towards RESRPIRATORY ALKALOSIS

2.mInute ventilation is calculated by multiplying the tidal volume with respiratory rate. Here patient sample, RR= 30 b/mt, tidal volume Vt= 500, mVe= RR× Vt= 30× 500= 1500= 15 l/ mt

PCo2 = 34 ; so as per sample increased minute ventilation has washed out the CO2 level in the body . And the pH level has moved into respiratory alkalosis with HCO3 in normal level..

3. Possible cause of arterial hypoxemia can be pulmonary embolism followed by thrombophlebitis,as there are chance of clot lodging in arteries and prevent blood to flow to the lung to pick the oxygen; resultingbin hypoxemia.

4.The patient respinse has improved and the values has moved to normal , as Pa Co2 is in normal range and pH is in normal level compared to sample 1.

Intervention:

1. Moderate hypoxemia with respiratory alkalosis, possibility of Pulmonary embolism as patient has history of thrombophlebitis and experienced SOB and chest pain, with expirational wheezing to be ruled out by CT as it cannot be visible by a Chest Xray.

2. CT chest to be done at the earliest.

3. Patient has to be started with anticoagulant at the earliest and treated at earliest with reference to a cardiology and pulmonary consultation. Fowlers patient to be provided.avoid exertion and provide rest.