Lade Adeleke
CASE STUDY
A 49years old white male present to the emergency room complained of choking while eating dinner at the nursing home he resides. He has a significant past medical history of traumatic brain injury, Asthma, Pneumonia, seizure disorder and Spasm quadriparesis. Patient denies shortness of breath, chest pain and fever, family history is noncontributory.
On Physical examination patient is well nourished, no signs of distress, alert and awake and the vital signs reveal * Blood pressure 110/60 * Pulse 96 * Saturation 90% * Heart sound – normal * No cyanosis * Breath sound- diminished on the right lung and patient was afebrile.
Healed tracheostomy and there was increased spasticity on the left arm and left leg. The patient is currently on the following medications: * Atorvastin for cholesterol * Bedofen for muscle spasm, * dantrium for spasticity, * Famotidine for GERD, * Depakote for seizures.
Blood gas and X-ray was ordered and the ABG result reveal “A PARTIALLY COMPENSATED RESPIRATORY ACIDOSIS WITH MODERATE HYPOXEMIA. PH 7.31, PCO2 65, HCO3 34.2, Pa02 50, Sp02 83.5%. The first X-ray shows no active disease. However, repeat x-ray 3 hours later showed complete opacification of the right lung and right upper lobe atelectasis. posteroanterior chest radiograph is shown below
Lab Work His white blood cell count is 10.4 x 109/L(5.0-10.0x109) with 78%(normal is 40-75%) segmented neutrophils, these elevated white blood cell indicates some infection going on and He is also mildly anemic since his hemoglobin count is 11.0 g/dl compared to the normal 13.5-16.5 and his platelet count is within normal limits (252 x 109/L).
DIAGNOSES
Dr. Sharif Ahmed diagnosed an ASPIRATION PNEUMONIA
TREATMENT
Patient was treated with a BPAP, antibiotics were started with Zosyn and Levaquin, nebulization (albuterol 2.5 mg) and steroids (budesonide) was also assumed. Another ABG was run and this is the result: PH 7.36,
A 49years old white male present to the emergency room complained of choking while eating dinner at the nursing home he resides. He has a significant past medical history of traumatic brain injury, Asthma, Pneumonia, seizure disorder and Spasm quadriparesis. Patient denies shortness of breath, chest pain and fever, family history is noncontributory.
On Physical examination patient is well nourished, no signs of distress, alert and awake and the vital signs reveal * Blood pressure 110/60 * Pulse 96 * Saturation 90% * Heart sound – normal * No cyanosis * Breath sound- diminished on the right lung and patient was afebrile.
Healed tracheostomy and there was increased spasticity on the left arm and left leg. The patient is currently on the following medications: * Atorvastin for cholesterol * Bedofen for muscle spasm, * dantrium for spasticity, * Famotidine for GERD, * Depakote for seizures.
Blood gas and X-ray was ordered and the ABG result reveal “A PARTIALLY COMPENSATED RESPIRATORY ACIDOSIS WITH MODERATE HYPOXEMIA. PH 7.31, PCO2 65, HCO3 34.2, Pa02 50, Sp02 83.5%. The first X-ray shows no active disease. However, repeat x-ray 3 hours later showed complete opacification of the right lung and right upper lobe atelectasis. posteroanterior chest radiograph is shown below
Lab Work His white blood cell count is 10.4 x 109/L(5.0-10.0x109) with 78%(normal is 40-75%) segmented neutrophils, these elevated white blood cell indicates some infection going on and He is also mildly anemic since his hemoglobin count is 11.0 g/dl compared to the normal 13.5-16.5 and his platelet count is within normal limits (252 x 109/L).
DIAGNOSES
Dr. Sharif Ahmed diagnosed an ASPIRATION PNEUMONIA
TREATMENT
Patient was treated with a BPAP, antibiotics were started with Zosyn and Levaquin, nebulization (albuterol 2.5 mg) and steroids (budesonide) was also assumed. Another ABG was run and this is the result: PH 7.36,