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 7.491, PCO2 27.6, PO2 53.6, HCO3 20.6, and oxygen saturation 90% on room air.

QUESTION

(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?

Answer 1

ABG refers to Arterial Blood Gas analysis measures oxygen and carbondioxide level in blood,it also measures acid base level in blood.In general it is used to assess tge level of gas in the blood

According to National Institute of Health the normal value is

pH - 7.35 to 7.45

PO2 - 75 to 100mmHg

PCO2 - 35 to 45mmHg

HCO3 - 22 to 26mEq/L

O2 - 94 to 100%

Based on the above given results the pH is above normal level which shows alkalosis and the partial oxygen and cardondioxide level is less than the normal which says the patient is having Respiratory alkalosis.

2.Based on the findings above described the clinical diagnosis is patient is suffering with Chronic Obstructive Pulmonary Disease.

3.The medications that can ordered by health care provider are

• Bronchodilators-Salbutamol,theophylline
• Steroids -Predinisolone,Dexamethasone
• Supportive oxygen therapy

4.Difference between BiPap and CPAP are

Bipap stands for Bilevel Positive Airway Pressure -it is a non invasive form of therapy used for patients with sleep apnea,lung disease and respiratory weakness.In BiPap ot has two pressure settings in which a prescribed pressure for inhalation and a lowerpressure for exhalation is done.

CPAP stands for continuous Positive Airway Pressure used to treat sleep apnea where in this a continuous stream of pressurized air enters the airways to prevent from collapse of lungs