A 59 year old carpenter came into the emergency room complaining of shortness of

Question

A 59 year old carpenter came into the emergency room complaining of shortness of breath. His pulse was 112/min and his blood pressure 138/88mmHg. His respiratory rate was 35/min, and his breathing was extremely labored. Loud breath sounds with some crackling were heard over all lung fields. The patient had an ashen complexion and his nail beds were cyanotic. An arterial blood sample was drawn and sent to the lab for blood gas analysis. A chest X-ray was ordered and the patient was given oxygen to breathe.

Given the information you have about the patient, predict the deviations from normal (increase, decrease, no change) you would expect him to have in the following parameters before he was given oxygen.

PaO2 (mmHg)__________________________??

PaCO2 (mmHg) ________________________??

pHa __________________________________??

  30 minutes later, the patient was found to be unresponsive. His complexion had changed to a flushed pink with no trace of cyanosis. His respiratory rate was 9/min and his breathing was quiet. His heart rate was 140/min and his blood pressure was 85/50mmHg. The patient was in a deep coma.

Compared with the time the patient came into the ER, predict the changes in the values of the parameters below (increase, decrease, no change) when he became comatose. Explain your predictions.

PaO2 (mmHg)__________________________??

PaCO2 (mmHg) ________________________??

pHa __________________________________??

When the patient was first admitted, his respiratory rate was 35/min. When he was comatose, his respiratory rate dropped to 9/min. What caused the change? Explain the sequence of events that caused him to become comatose.________________?? (answer this question)

Explanation / Answer

(A). Initially,

PaO2 (mmHg)_____Decreases (due to decreased oxygen saturation)____

PaCO2 (mmHg) _____Decreases (due to decreased carbondioxide saturation)___________________

pHa _______________Increases___________________

(B). After 30 minutes,

PaO2 -----------------> Decreases

PcCO2-------------------> Increases

pH ----------------------------> Decreases

(C). During coma PaCO2 increases. Increased PaCO2 causes respiratory arrest.

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