The Emergency Department Of A County Hospital

1083 WordsDec 6, 20155 Pages
A sedated 72-year old male was admitted to the emergency department of a county hospital. The patient was complaining of chest pain and shortness of breath. This patient has a history of COPD, type-two diabetes and has quit smoking for nearly seven years. In the emergency department, the patient had labored breathing and a SpO2 of 72% on room air. This patient was then placed on BiPAP. His weight is 117kg and temperature of 99.1. Blood pressure was 61/41 on arrival to the emergency department and the patient was tachycardic with a heart rate of 145bpm. An EKG showed the patient was in atrial fibrillation with rapid ventricular response. IV fluids were given in the right antecubital and norepinephrine was administered. While the patient was on BiPAP with 100% FiO2, he had a SpO2 reading of 80%. The doctor decided to intubate the patient with an oral endotracheal tube size nine. Prior to the procedure the patient was sedated with fentanyl. The patient was put on PRVC with 100% FiO2. A chest x-ray showed that the endotracheal tube was in the correct placement and had a prominent ill-defined rounded opacity overlying the left mid lung with additional patchy airspace disease involving the remainder of the left lung. On auscultation, there were scattered crackles and rhonchi on the left side and the right side was diminished. A complete blood count was ordered on this patient and the results showed increased white blood cells at 26.2 and an increased glucose 194, BUN 82, and
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