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Found unresponsive by son. Intubated in field. Vent Settings A/C with a VT of 5 ml/kg, RR of 20 bpm, PEEP of 5cmH2O, and an FiO2 of 1.0. CXR showed pulmonary vascular congestion and pulmonary edema. Breathing treatments ordered. ABG revealed a partially compensated respiratory acidosis with excessively corrected hyperoxemia. Labs revealed a normal WBC count and low potassium levels.
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CXR revealed pulmonary edema, Labs low potassium levels and a normal WBC count. ABG revealed a uncompensated metabolic alkalosis with mild hypoxemia. Went from a respiratory to a metabolic issue.
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CXR revealed a pulmonary vascular congestion. ABGS's revealed a uncompensated metabolic alkalosis. RR decreased to 8 bpm. FiO2 at .30. Labs revealed low potassium levels and elevated WBC count. Antibiotics ordered.
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Labs still showed low potassium levels and WBC increased. ABG still revealed a compensated metabolic alkalosis with mild hypoxemia. Vent settings remain the same.
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CXR revealed peristent infiltrates throughout each lung significant with Pneumonia. This would explain the increased WBC count. Potassium levels were back to normal and potassium was discontinued. ABG revealed a compensated metabolic alkalosis mild hypoxemia. Vent changes ordered to PSV with a RR of 5, PEEP of 5 cmH2O one hour BID as tolerated. Failed and switched back to previous settings.
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PSV RR of 16 bpm, PEEP of 5 cmH2O. Tolerated well. T-piece trials started. ABG still revealed a compensated metabolic alkalosis with mild hypoxemia. T-piece trial initiated lasted 15 minutes and switched back to PSV due to RR between 39-40 bpm. FiO2 increased to .50.
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CXR revealed emphysema and possible right basilar atelectasis. Sedation discontinued and PS decreased to 12. ABG revealed a partiall compensated metabolic alkalosis with mild hypoxemia. Dr. Knowall ordered her to be extubated once awake and if fails possibly a trach will be performed. CHF had improved. CXR showed worsening of inifiltrates on top of the emphysema and bibasilar atelectasis. Did well once extubated. Treatments and antibiotics continued.
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Continued to improve on floor.
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She was discharged.
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Patient readmitted for unresponsiveness not intubated, sent to ICU for further observation. ABG revealed a partially compensated respiratory acidosis with moderate hypoxemia. .
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WBC count back within normal ranges.
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SpO2 fluctuating between 88-92% . Increased SOB still and worsening. Dr. Knowall is still trying to find out the underlying cause.
