A.W., a 52-year-old woman disabled from severe emphysema, was walking at a mall

Question

A.W., a 52-year-old woman disabled from severe emphysema, was walking at a mall when she suddenly grabbed her right side and gasped, “Oh, something just popped.” A.W. whispered to her walking companion, “I can't get any air.” Her companion yelled for someone to call 911 and helped her to the nearest bench. By the time the rescue unit arrived, A.W. was stuporous and in severe respiratory distress. She was intubated, an IV of lactated Ringer's (LR) to KVO (keep vein open) was started, and she was transported to the nearest emergency department (ED). On arrival A.W. is stuporous, tachycardic, and cyanotic. The paramedics inform the physician that it was difficult to ventilate A.W. arterial blood gases (ABGs) are obtained. A.W. Her ABGs on 100% oxygen are pH 7.25, Paco2 92 mm Hg, Pao2 32 mm Hg, HCO3 27 mmol/L, base excess (BE) +5 mmol/L, Sao2 53%. 1. On arrival to the ER what assessments would be a priority for the nurse or doctor to perform? Be specific in your answers. 2. What exams and lab tests would you suggest to be done and why. 3. What do you think the diagnosis would be for this patient? 4. Describe the findings of the arterial blood gas results.

Explanation / Answer

Ans 1: On arrival to the ER the priority is to perform the Physical Examination. Pay Particular attention to the breathing sounds, heart sounds and general appearance of the patient.

Ans 2: Following exams and Lab tests need to be done:

- Chest X Ray - T identify the changes in the lung. It can also identify presence of infection or any mass in the lungs.

- Lung Function test: To check the functioning of lung.

- Blood test to evaluate for genetic disease, WBC count

- ABG analysis.

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