An MS Patient with a respiratory problem

[meka]

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

[add1]

good question.....

[Hope2Pass]

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.

[kdoc]

Opiod overdose

[patelMD]

Originally Posted by Hope2Pass

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!

[sana akbar]

i think its aspiration pneumonia....

[heights]

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.

[sana akbar]

yes,bcz only opiods cause respiratory depression...none other....

[patelMD]

Originally Posted by sana akbar

yes,bcz only opiods cause respiratory depression...none other....

OD on barbiturates also causes Respi Depression.

(Not in this case)

[Lena]

Opiods, its the only one that makes sense.

[greer1155]

Originally Posted by sana akbar

yes,bcz only opiods cause respiratory depression...none other....

Opiod OD is correct. It is all about the respiratory rate and I missed it! Every other condition would cause tachypmia, NOT Bradypnia. Respiratory acidosis in the presence of decreasing resp rate is one of two things. Something depressing the RR (oipiods) or verging on total respiratory failure which she obviously is not since she wakes enough to be combative.
The ONE piece of info in this question that is the differentiator is the RR and its easy to miss! I did and picked Aspiration thinking of the MS as well. They do love their distractors!!!!

[ucheeee]

Originally Posted by meka

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

So what's the answer?

[Dr.Sam vishad]

Originally Posted by ucheeee

So what's the answer?

opioid overdose

[tafseer90]

reasons .. its not A because ARDS causes bilateral pulmonary edema and that has findings on ausculatation of chest and has V-Q mismatch rather than respiratory acidosis ...
not B because aspiration pneumonia has more involvement of right side and no ausculations findings and no features of pneumonia

not D because PE is acute ,. and has tachypnea and this pt has low RR ....

not E .. upper airway obstruction has stridor ..


low gag can cause aspiration pneumonia again and again and this pt has low lung volume so that fits but aspiration pneumonia would have tachypnea as a response