243) A 65 year old man with a long history of COPD and history of metastatic colon cancer presents with complaints of increasingly severe shortness of breath that occurred at rest today. He reports that his symptoms are much more severe than his usual baseline. On examination , he is afebrile and tachypneic. Blood pressure is normal. Chest exam reveals occassional rhonchii. EKG shows sinus tachycardia. Arterial blood gases are obtained on the room air and show Ph : 7.45 Po2 40 PCo2 50 and Bicarbonate of 36. Chest X-ray shows changes of emphysema. His home medications include ipratropium and albuterol inhalers. He is placed on 4 liters oxygen by nasal cannula.
Which of the following is the most appropriate next step?
A) Intravenos corticosteroids
B) Intubation
C) Spiral CT scan and empiric Low molecular weight heparin
D) Non invasive positive pressure ventilation
E) Bed-side Spirometry
C is the answer
pt may have PE, so cccccccc
c
c
Maybe my mind is not working but can PE explain the ABG findings… Ph : 7.45 Po2 40 PCo2 50 and Bicarbonate of 36.. looks like pa tient has metabolic alkalosis.. shouldnt the COPD cause acidosis.. I wanna go with C but something tells me the answer is B..
yup u rt….so c is gud 1
same here , but intubating a pt with COPD ???
Although the risk and suspicion for PE is high in this case, I think the ABG does not correlate with this at all, co2 should be less than 50. I think Non pressure ventilation is the right answer as it will help tremedously with hypoxia and acidosis.
correction- answer is C. Chronic respiratory acidosis and compensatory metabolic alkalosis seen with copd, that is the reason for elevated hco3, pt could still have PE since his thrombotic risk is high and not reflected in his ABG.
B