Respiratory Case Study

Respiratory Case muse The following case study is of a 37-year old Hispanic male weigh 145 lbs and 70 inches tall shew unconscious by his girlfriend. According to her he was unconscious for about 15 hours and she was refer because he would not wake or respond and was breathing sh throw in and bleak. She accordinglyce called 9-1-1. The long-suffering entered the ER by parking brake vehicle and on my initial judicial decision Pt had an altered mental status, was in truth unresponsive masking symptoms of a manageable drug overdose.The girlfriend told the medical student the Pt had taken 75 mg of synthetic heroin and an un ack flatledgen amount of Xanex and other amounts of Benzodiazepines. On judgment, the doctor noticed his altered mental status and unconscious status. He had a gag reflex and responded to pain. Pt had a blood pull of 63/41 and a 02 vividness of 50% on room air and a stock ticker stray of 108. We put the patient on an oxy mask at 14 liters and his sa turation improved to 90%. The Physician then administered Narcan which in return raised the respiratory place. The doctor then at long last intubated with Etomidate.He is then diagnosed with shrill Renal Failure, Acute Lung Injury with accomplishable aspiration and CHF with atrial Fib. The patient has had no prior archives of drug overdose. The patient did, however, come a brother that recently committed self-annihilation and was recently released from jail. The patient does drink alcoholic drink and takes multiple street medications and methadone for pain. For this patient with my initial thoughts would be to order an ABG to ravel for acidosis and contain if there is an electrolyte imbalance, then a possible scan of the brain.An EKG test would alike be logical to see how the centre has dealt with the stress. Giving him Narcan would second block the receptor sites to stop the follow up of the OD. What ended up being staged is the ABG, a CT of the brain, EKG, NG el ectron resistance, Catheter, Glasgow swooning Scale, Chest X-ray and the science lab displace blood. The ABG showed severe metabolic and respiratory acidosis, glucose of 72, thousand of 4. 9, calcium of 7. 9 chloride of 105, C02 of 24, creatinine of 2. 6. The EKG showed atrial fibrillation with rapid ventricular response and signs of CHF.The lab results showed an electrolyte imbalance, sepsis, and no alcohol. The CT scan showed a hypoxemic brain injury and the x-ray showed infilt grazes which be assumed to be from aspiration pneumonia. From this we k this instant that the patient will stay intubated until hike value of acidosis, help to reduce possible development of ARDS, Sepsis and until the patient will be able to breath on his give. The settings on the vent I would have chose would have been SIMV, Vt of 550-600, a rate of 15, pressure delay of 10, Cpap of 5, at a c% Fi02 with the ABG read Ph 7. 1, Pco2 58, P02 56, and sating 76%, Hco3 18. 4. Physician ordered vent s etting, SIMV, ampere-second% Fi02, Vt of 550, rate of 12, pressure stand out of 10, Cpap of 5. The idea behind these settings is to allow the Pt to ventilate and to breathe reach the access co2 and to oxygenate the blood. I would like to have seen a rate of 16 to help with the release of co2. 1 hour later the ABG read Ph 7. 13, Pco2 65, P02 66, Hco3 at 15. 6 and sating 85%. The settings for the Pt as far as respiratory seem to be fine for now unless(prenominal) the Pt develops ARDS.It is more of a metabolic concern at this time now that the Pt is ventilated. affinity gases go as follows in the ER for initial assessment on the vent at 2130 a critical of Ph- 7. 11, Pc02- 58, P02- 56 Hc03- 18. 4 and a saturation of 76% on speed of light% Fio2 while on SIMV with a rate of 12, Vt of 550, pressure support of 10 and Cpap of 5. The Pt at this time has no extemporaneous breathing while on the vent. ascribable to the drug overdose the Pt is showing both respiratory and metabolic acidos is with admit Hypoxemia. A follow up ABG, 20 minutes later, results in a Ph of 7. 3, Pco2- 47, Po2- 66, Hco3-15. 6 and sating 85% on 100% Fio2. The Pt is now breathing 21 BPM and a Vt of 605 in increment of the vent settings. The results of the latest ABG have shown dinky improvement, but still critical Ph and moderate hypoxemia. Another follow up ABG at 0100 shows a small improvement on the Ph to 7. 18, the Pco2 became more acidotic moved to 53, the Po2 improved to 77 which shows he is oxygenating better but still hypoxic, his Hco3 acidosis is upward(a) at a change to 19. 8, and sating 91% now.The Pt is now breathing at a rate has come take down to 10 BPM on his own above and beyond the vent. After consulting with the physician we changed the Vt to 600 and the pressure support to 20 and Cpap to 15. The Pt proceed on these settings till 0415. The physician then made the change to Bi-level with the settings of a rate of 14 pressure support of 25, and an H/L pressure of 35/15. T he Pt at this time is move a Vt of 745 and a spontaneous rate of 17 and still at 100% Fio2 and sating 92%. This is the point when the Pt makes the turn.The Bi-level or APRV was the proper setting for this Pt. He continued to improve over the next several(prenominal) days with his peek pressure mount to 40. The Pt continues these settings and lento improves and eventually deprive from the ventilator till the Pt no longer needs support. Pt have AP diameter X-ray to confirm tube attitude and to see if there were every kind of infiltrates because of possible aspiration and to happen possible pneumothorax and pleural effusion. Findings included round the bend patchy infiltrates in the right swiftness to middle lobes.The left lower lobe excessively has some similar findings but less concerning. This may either be delinquent to lung infection or pulmonary edema. The placement of the ET tube was substantiate at 2 cm above the carina. The NG tube was also confirmed to correct pla cement. The heart silhouette was not enlarged and stable. No pleural effusion was ever confirmed. Pt will be acted for squirt Pneumonitis. X-rays continued throughout his stay and infiltrated were slowly diminished and tube placement was confirmed and never changed. The Lab account sodium at 142 to be within ruler range, potassium 5. also with in habitual range. Chloride at 105 also with in normal range, glucose levels at 169 also within normal range, calcium at 7. 9 is low. The Pt reliable ionized calcium through his central line. The Hematology reported the WBC at 4. 4 is at the lower spectrum of normal, the RBC at 5. 70 is within the normal limits, and HCT is 51 which ar also in the normal spectrum. Blood work came back good. Sputum savor was taken and results were negative for any growth. The Pt is urinating well and color is yellow/ loose with trace amounts of protein.No PFTs were performed. Medications the Pt received in the ER Dextrose 5% delivered intravenous to hyd rate Pt, sodium bicarbonate was stipulation intravenous because of the severe acidosis, Nor adrenaline granted up intravenous to raise the BP to a more stable condition, Dopamine also given for a vaso pressers, Etomidate was given to composed the Pt for intubation, Clindamycin given due to the allergic reaction of Penicillin to help with any anaerobic infection, Doripenem and vancomycin other antibiotics, Propofol to keep Pt sedated during his intubation.Medications given while in the ICU Clopidogrel (Plavix) given to forestall clots, Symbicort given to help prevent bronchospasm and improve lung function, Digoxin given for the CHF and slow the heart rate for Atrial Fibrillation, famotidine to inhibit the production of stomach acid, lisinopril given in case of hypertension, Sodium Chloride to treat his hyponatremia, Levophed (Nor epinephrine) given when the HR or BP drops, Phenylephrine also a vaso presser or to relive nasal decongestion, Pitressin also another(prenominal) vas o presser, Dobutamine to prevent cardiogenic shock, Dopamine for another presser, Fentanyl given to reduce pain, Haloperidol (Haldol) to help with his mental heath, Lorazepam also given to treat his mental heath or anxiety, morphia to treat pain, and Reteplase given for anti-clotting factor.