Ralph Rutherford was a 23-year old L1 (first year law student). Three days befor
ID: 3480282 • Letter: R
Question
Ralph Rutherford was a 23-year old L1 (first year law student). Three days before his death, Ralph had an upper respiratory infection, with nasal and chest congestion and a fever of 101.8 °F. He was exhausted from "just trying to breathe", and the bronchodilator inhaler was not working. On the third day of his illness, Ralph's girlfriend took him to the ER of the local hospital. He had inspiratory and expiratory wheezes and was in severe respiratory distress The Table below shows the information obtained when he arrived at the ER at 4 PM. Respiratory Rate 30 breaths/min (normal 12-15 0.21 (room air 7.48 (normal 7.40 55 mm HH 32 mm H Fio2 (fractional concentration of O2 PAo2 (arterial Po2 Paco2 (arterial Pcoz The ER staff treated Ralph with an inhaled bronchodilator and had him breathe 50% oxygen. At 6 PM, his condition had not improved, in fact, it had worsened, and Ralph was obtunded. Before proceeding with more aggressive treatment (e.g. anti-inflammatory drugs and intubation), the ER staff obtained a second set of measurements. The Table below shows the information obtained when at 6 PM Respiratory Rate Fio2 (fractional concentration of O2 8 breaths/min 0.5 PAo2 (arterial Po2 Paco2 (arterial Pco2 7.02 45 mm H 80 mm H Ralph died before aggressive treatment could be initiated. At autopsy, his airways were almost totally occluded by mucous plug:s. These questions are asking about mechanisms operating to regulate life processes (i.e. the HOW or the WHY events occur). These questions MUST be answered by stating a MECHANISM or PATHWAY. Just saying that something occurs, or that "it goes up" is not a mechanism or pathway. Mechanisms and pathways are the molecular and/or cellular steps involved in the final outcomeExplanation / Answer
Resistance is given by the formula Hagen poiseuille law
R= 8nl/r4.
He states that radius is inversely proportional to resistance. As the radius decreases the resistance increases. In this case when the patient arrived ER his airway diameters has reduced to 50%. So as it decreases the resistance increases.
In this case the respiratory tract infection has caused constriction of bronchial airways thus increasing the tubulence also. So the alveolar ventlation also decrease due to both reduced diameter of airways and turbulent airflow.
when this occurs, the secretion of pulmonary surfactant decreses. Hence the transmural pressure exerted by surfactant decreases and fails to counteracts the interstitial hydrostatic pressure. Hence it results in collapse of alveoli along with pulmonary edema. This is the reason for formation of mucus plugs resulting in low po2 and high pco2. So along with bronchodilator and oxygen theapy it is advisable to add surfactant.
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