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  #1  
Old 03-13-2012
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Lungs How would manage this arterial blood gas on ventilator!

A 67-year-old woman has been intubated for 1 week after undergoing a left lobectomy for lung cancer. She has chronic obstructive pulmonary disease. Her preoperative functional vital capacity was 40% of predicted. She is awake and alert. Her blood pressure is 130/75 mm Hg, and pulse is 72/min. The ventilator settings are a synchronized intermittent mandatory ventilation of 8/min, FIO2 of 40%, and positive-end expiratory pressure of 5 cm H2O. Arterial blood gas analysis shows:

pH 7.42
PCO2 47 mm Hg
PO2 90 mm Hg
O2 saturation 96%

Which of the following is the most appropriate next step in management?
A) Antibiotic therapy
B) Bronchodilator therapy
C) Chest physiotherapy
D) Decrease inotropes
E) Diuretic therapy
F) Fiberoptic bronchoscopy
G) Heparin therapy
H) Incentive spirometry
I) Increase FIO2
J) Increase inotropes
K) Increase respiratory rate
L) Placement of thoracostomy tube
M) Tracheostomy
N) Wean from the ventilator
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Old 03-14-2012
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K. inc resp rate, bcoz pt is retaining CO2 and O2 conc is also lil bit low, so if we are inc resp both will correct.
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Old 03-14-2012
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Originally Posted by usmlepak View Post
K. inc resp rate, bcoz pt is retaining CO2 and O2 conc is also lil bit low, so if we are inc resp both will correct.
but then it wil make her more alkalotic. she is already at pH=7.47. what say?
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Old 03-14-2012
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Originally Posted by tyagee View Post
but then it wil make her more alkalotic. she is already at pH=7.47. what say?
pt ph=7.42 that's in compensatory for CO2 retention, when we will correct co2 ph will come to normal range, i think we have to inc resp rate.
if any one have any authentic reason plz mention
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Old 03-14-2012
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Why not extubate / liberate her from the ventilator?
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Old 03-14-2012
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The COPD pts often have chronic CO2 retention and you intubate them if there is worsening drop in pH indicative of worse respiratory acidosis. this pts does not have repiratory acidosis and his CO2 retention is normal for COPD Pts. so i suggest the patient should be wean off ventilator . ans N. increasing respiratory rate will increase the resp. alkalosis and increasing the Fio2 will remove her hypoxic drive.
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Old 03-16-2012
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Answer is N

Source: I've been living, I mean rotating in the MICU for too long

She's awake, alert, PEEP of 5, FIO2=40, ph and pCO2 are normal for COPD, chronic COPDers are retainers.

So start weaning spontaneous breathing trials on CPAP.
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