2. Carl Casill is a 75 year old male with chronic bronchitis has a barrel chest
ID: 15150 • Letter: 2
Question
2. Carl Casill is a 75 year old male with chronic bronchitis has a barrel chest and cyanosis of the lips and fingers. His pulse oximeter reads 86% oxygenation on room air. His PaO2 is 54 mm Hg. His PaCO2 is 56 mm Hg.He is put on low-flow oxygen but complains of shortness of breath. His wife turns the O2 up to 6 liters/ minute. He is found unresponsive, Respiratory Rate = 4 per minute, with a PaCO2 of 79 mm Hg and a blood pH of 7.2.
a. Analyze his ABGs: is the initial PaO2 high or low? PaCO2 high or low?
b. What happened to the pH? Why?
c. He went into a coma because of the change in oxygenation of his blood. Why would that trigger the mental status change and low RR (hint: consider his diagnosis and what drives his breathing) ?
d. What caused him to have a barrel chest?
e. Explain the mechanism of chronic bronchitis.
Explanation / Answer
intial PaO2=LOW, PaCO2=HIGH PH is less than 7.35 and C02 is higher than 45 because of respiratory acidosis. if his rr decrease you are retaining acid-c02, giving you more acidosis The Kidneys excrete HCO3 (base) and retain H+ to compensate. The Respiratory System tries to compensate with hypoventilation to retain CO2 (acid) to decrease the Alkalosis. reduced surface area,cant get C02 out!, smoke breaks down alveoli, is restrictive. The alveoli start fusing into big alveoli and there is greater surface area with small ones=gas exchange is reduced. alveoli get overdistended cant get rid of C02 and there is not enough room to get out. Bronchitis is usually there also and cant blow enough air out. barrel chest is bc of large alveoli taking up so much room and there is decrease in compliance.
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