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Case Study: Acute Respiratory Distress Syndrome
Transcript of Case Study: Acute Respiratory Distress Syndrome
Ms. Y is a 23 year-old woman who was feeling fine until the morning of admission when she began having severe chills, vomiting, diarrhea, headache, and fever of 40*C. The symptoms persisted throughout the day and caused her to seeek medical attention at the local ED. Ms. Y had an intrauterine device (IUD) insterted at a local family planning clinic 3 days before admission. At the time of admission she denied shortness of breath, wheezing, sputum production, cough hemoptysis, orthopnea, chest pain, ilicit drug use, or exposure to TB. Physical Exam:
Pt is well-nourished, alert & oriented; she appears anxious but there is no evidence of respiratory distress
Temp 40*C; RR 24 bpm; HR 104/min; BP 126/75
Normal configuration & expansion while breathing; normal resonance to percussion bilaterally
Lower abdominal tenderness to palpation
No cyanosis, edema, or clubbing Lab Data:
WBC 15,500 (high) Question #1
-Does the patient appear to have a pulmonary problem at this time? No Although the pt appears to have a high RR & HR, this may be due to her high fever. She still needs to be watched closely to make sure her pulmonary status does not change. Question #2
-Does the patient's medical problem predispose her to the development of ARDS? Yes... Although the pt presents with no resp distress at this time, she does have the potential in developing bacterial infection from the UID. This bacterial infection can possibly lead to sepsis, which accounts for about 30% of ARDS cases -Ms. Y has been started on IV antibiotic therapy. Results of a uterine swab shows gram-negative diplocci, and a preliminary blood culture also shows gram-negative cocci.
-Twelve hours later, she begins complaining of increased shortness of breath. Assessment:
-RR 34 bpm; HR 120/min
-She is using accessory muscles to breathe and chest auscultation now reveals fine, inspiratory crackles bilaterally. ABG: on RA
-PaCO2: 21 mmHg
-HCO3: 16 mEq/liter
-PaO2: 62 mmHg
SaO2: 88% Question #1
-What is the pt's acid-base & oxygenation status? Metabolic acidosis with partial compensation and mild hypoxemia Question #2
-What pathophysiology accounts for the adventitious lungs sounds (fine, inspiratory crackles)? Fine inspiratory crackles may indicate abnormal air movement through fluid-filled airways. The pt continues to experience severe respiratory distress and is given an entraintment device w/an FiO2 of 60%. ABG on 60%
-PaCO2: 35 mmHg
-HCO3: 16 mEq/liter
-PaO2: 49 mmHg Assessment:
-RR 38 bpm
-HR 134/min Chest X-ray Question #1
-What does the chest X-ray demonstrate? Onset of diffuse bilateral infiltrates in the lower lobes; greater on the pt's right side. Question #2
-Interpret the ABG.
-What would you recommend? Non-compensated metabolic acidosis w/moderate hypoxemia. Mechanical Ventilation