Respiratory Case Study

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Respiratory Case Study

The following case study is of a 37-year old Hispanic male weighing 145 lbs and 70 inches tall found unconscious by his girlfriend. According to her he was unconscious for about 15 hours and she was concerned because he would not wake or respond and was breathing shallow and slow. She then called 9-1-1. The patient entered the ER by emergency vehicle and on my initial assessment Pt had an altered mental status, was very unresponsive showing symptoms of a possible drug overdose. The girlfriend told the physician the Pt had taken 75 mg of methadone and an unknown amount of Xanex and other amounts of Benzodiazepines. On assessment, the doctor noticed his altered mental status and unconscious status. He had a gag
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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 improving at a change to 19.8, and sating 91% now. The Pt is now breathing at a rate has come 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 continued 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. The Pt at this time is pulling 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 days with his peek pressure climbing to 40. The Pt continues these settings and slowly improves and eventually weaned from the ventilator till the Pt no longer needs support.

Pt received AP diameter X-ray to confirm tube placement and to see if there were any kind of infiltrates because of possible aspiration and to eliminate possible pneumothorax and pleural effusion. Findings included mild patchy infiltrates in the right upper to middle lobes. The left lower lobe also has some similar findings but less concerning. This may either be due to lung infection or pulmonary
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