Mr. F., a 68-year-old man, is admitted to the critical care unit from the emerge
ID: 137831 • Letter: M
Question
Mr. F., a 68-year-old man, is admitted to the critical care unit from the emergency department with respiratory failure and hypotension. His history is significant for type 2 diabetes mellitus, steroid-dependent chronic obstructive pulmonary disease, peripheral vascular disease, and cigarette and alcohol abuse. His medications at home include glipizide, prednisone, and a metered-dose inhaler with albuterol and ipratropium (Combivent). In the emergency department he received a single dose of ceftriaxone and etomidate for intubation.
On exam he is intubated, on pressure-controlled ventilation, and receiving normal saline at 200 mL/hr and dopamine at 8 mcg/kg/min. His blood pressure is 86/50 mm Hg; heart rate, 126 beats/min; oxygen saturation, 88%; and temperature, 39.6°C. His cardiac rhythm shows sinus tachycardia and nonspecific ST-T wave changes. Arterial blood gas values are as follows: pH, 7.21; PaO2, 83 mm Hg; PaCO2, 50 mm Hg; and bicarbonate, 12 mEq/L. Other laboratory values are as follows: serum glucose, 308 mg/dL; serum creatinine, 2.1 mg/dL; and white blood cell count, 19,000/ microliter.
Questions
What disease state do you suspect this patient to experience and why?
What potential endocrine complications do you anticipate?
What further laboratory studies would you want? What results do you anticipate?
What treatment goals and strategies do you anticipate?
In providing patient and family education and support, what issues need to be addressed immediately and which can be delayed?
Explanation / Answer
Answer: The person is suffering from multiple diseases of states as he is having COPD, Diabetes , hypotension and also autoimmune diseases along with endocrine complications. He is havng respiration problem as he is unable to breathe properly due to alcohol and cigarette abuse.
Answer: The spectrum of acute and potentially life-threatening changes after brain injury and spinal cord injury vary widely, relating to the severity and level of injury. Anemia occurs acutely through blood loss from concurrent vascular trauma, and subacutely as a result of GI bleeding. There can be multiple problems regarding the endocrine disorder.
Answer : The laboratory studies may include for the following reasons:
Answer: The patient needs proper treatment regarding his health conditions and his family should takecare of the patient and decrease the consumption of alcohol and cigarettes. The Patient has severe COPD, that causes breathing problem as well as unable to eat anything.
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