A 61-year-old female was admitted last night with shortness of ...

[Ebrown]

A 61-year-old female was admitted last night with shortness of breath. She currently is alert and oriented but very anxious.
 
  Her latest arterial blood gas values, on a nasal cannula at 3 L/min, show: pH = 7.39; PaCO2 = 41 mm Hg; PaO2 = 40 mm Hg; SaO2 = 74; HCO3 = 24 mEq/L. Breath sounds are decreased throughout with fine late crackles on inspiration. The current chest X-ray shows an enlarged heart with bilateral vascular congestion. The most appropriate therapy for this patient is _________.
  a. NIPPV
  b. mask CPAP
  c. invasive ventilation
  d. nonrebreather mask

Question 2

A 62-year-old male patient with COPD is being seen in the pulmonary clinic for dyspnea at rest and daytime hypersomnolence.
 
  The patient has been hospitalized three times in the past year for COPD exacerbations and once for pneumonia. He currently uses 2 L/min oxygen from a concentrator all the time. The patient reports that he is able to sleep only about 2 hours each night and that he has a headache every morning. Which of the following should be recommended to the physician?
  a. Chest cuirass
  b. Nocturnal NIV
  c. Nocturnal CPAP
  d. Tracheostomy and ventilation

[sultansheikh]

Answer to Question 1

ANS: B
The arterial blood gas values for this patient show refractory hypoxemia, as evidenced by the PaO2 of 40 mm Hg while receiving supplemental oxygen. The breath sounds indicate pulmonary edema. This finding is supported by the chest X-ray, which shows bilateral vascular congestion and an enlarged heart. These findings are consistent with acute cardiogenic pulmonary edema. The most appropriate therapy is mask CPAP.

Answer to Question 2

ANS: B
This patient shows signs of nocturnal hypoventilation and poor sleep quality, as evidenced by the daytime hypersomnolence, dyspnea, and morning headache. This patient should be assessed fur-ther for the use of nocturnal NIV by testing for oxygen saturation overnight.

[Ebrown]

TYSM

[kswal303]

Excellent