A 55-year-old male with acute dyspnea is admitted to the ...

[TFauchery]

A 55-year-old male with acute dyspnea is admitted to the hospital. He is alert and oriented.
 
  His physical examination reveals: heart rate 120 beats/min and regular; blood pressure 146/88 mm Hg; temperature 38 C; respiratory rate 28 breaths/min shallow and labored. Breath sounds are decreased throughout with fine late crackles on inspiration, chest expansion is decreased in both bases. The patient is not coughing. The ABG on room air is: pH 7.52; PaCO2 30 mm Hg; PaO2 42 mm Hg; Hb-O2 80; HCO3 24 mEq/L. This patient is retired after working in a steel factory for 38 years and he has a 50-pack-year history of smoking. The most appropriate action for the res-piratory therapist to take is which of the following?
  a. Intubate and initiate positive-pressure ventilation.
  b. Initiate noninvasive positive pressure ven-tilation.
  c. Administer oxygen via a high flow nasal cannula.
  d. Initiate bronchodilator and mucolytic therapy.

Question 2

A 46-year-old male presents to the emergency department with a chief complaint of shortness of breath.
 
  Physical assessment reveals: pulse 102 beats/min, blood pressure 138/80 mm Hg, respiratory rate 25 breaths/min with accessory muscle use, and breath sounds are decreased with bilateral inspir-atory and expiratory wheezing with a prolonged expiratory phase. The peak expiratory flow rate is 100 L/min. The immediate action by the respiratory therapist should include which of the fol-lowing?
  a. Intubate and mechanically ventilate.
  b. Administer oxygen via nonrebreather mask.
  c. Administer continuous bronchodilator therapy.
  d. Initiate noninvasive positive pressure ven-tilation.

[lcapri7]

Answer to Question 1

ANS: C
According to the arterial blood gas (ABG) this patient is able to move air as evidenced by a par-tial pressure of carbon dioxide (PaCO2) of 30 mm Hg (respiratory alkalosis); therefore intubation and artificial ventilation are not necessary. The patient does not require noninvasive positive pressure ventilation (NPPV), because he is breathing. The patient does not seem to have evidence of requiring a bronchodilator and a mucolytic. The patient does, however, have moderate hy-poxemia. Since the patient is not a carbon dioxide (CO2) retainer, a high concentration of oxygen may be applied in the form of high flow nasal cannula.

Answer to Question 2

ANS: C
It would be inappropriate at this time to intubate this patient because he is still moving air, as ev-idenced by his respiratory rate and breath sounds (although he may be tiring). Noninvasive venti-lation is not appropriate for the same reasons. An arterial blood gas is necessary to establish the need for mechanical ventilation. This patient appears to be having an asthma exacerbation, as ev-idenced by his bilateral wheezing with a prolonged expiratory phase. The patient would probably benefit from oxygen therapy. However, the immediate problem and cause for alarm is his severe airflow obstruction, as evidenced by his breath sounds and peak expiratory flow rate (PEFR). Therefore, the most appropriate answer is to administer continuous bronchodilator therapy.

[TFauchery]

Excellent

[connor417]

TYSM