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  #1  
Old 05-15-2011
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Lungs An MS Patient with a respiratory problem

A 45 yr old woman with MS is brought to the ER with one hour history of increased confusion; she is now stupurous. She has been in remission for two years. Temp is 37.2, pulse 72, RR 8/min and bp 116/66.
Percussion of chest reveals low lung volumes. The lungs are clear to auscultation and the breath sounds appear distant. There is a poor gag reflex. When aroused she is mildly combative and moves all four limbs then drifts back into unconsciousness..
ABG-
PH 7.12
PCO2 76 mm hg
PO2 50 mm hg
What is the cause of her condition?
1. ARDS
2. Aspiration pneumonia
3. Opioid overdose
4. Pulmonary Embolism
5. Upper airways obstruction
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Old 05-15-2011
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good question.....

Last edited by add1; 05-15-2011 at 07:43 AM.
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Old 05-15-2011
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I would go with A) ARDS.

Im not quite sure but her other problems can be related to the fact that she has a demylenating disorder and a respiratory acidosis. Her respirations are really low so may be its because of ARDS.
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Opiod overdose
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Old 05-15-2011
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Quote:
Originally Posted by Hope2Pass View Post
I would go with A) ARDS.

Im not quite sure but her other problems can be related to the fact that she has a demylenating disorder and a respiratory acidosis. Her respirations are really low so may be its because of ARDS.

Yep, I agree with this!
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Old 05-15-2011
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i think its aspiration pneumonia....
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Old 05-15-2011
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The answer is opiod overdose.
- One hour confusion, she's now stuporous and has decreased gag reflex, and is combative when awakened. Classic opioid overdose, eg high dose heroin.
Opioid overdose causes respiratory depression and coma. Because of her low RR, she is not breathing off her CO2--> respiratory acidosis.

Ps. don't get tripped up by the fact that she has MS- she has been in remission for two years so for her to suddenly develop ARDS as a result of MS is highly unlikely. Patient's with MS get respiratory problems as a chronic sequelae because of respiratory muscle weakness.
Aspiration pneumonia occurs when someone is passed out and aspirate gastric contents. This is not the case here- this woman presented with confusion, i.e. she was awake so she wouldn't have aspirated. Hint- usually the case with aspiration pneumonia is the alcoholic or homeless man found unconscious.

Last edited by heights; 05-15-2011 at 03:55 PM.
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Old 05-15-2011
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yes,bcz only opiods cause respiratory depression...none other....
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Old 05-15-2011
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Quote:
Originally Posted by sana akbar View Post
yes,bcz only opiods cause respiratory depression...none other....
OD on barbiturates also causes Respi Depression.

(Not in this case)
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Old 05-15-2011
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Opiods, its the only one that makes sense.
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