Page 659 - Clinical Application of Mechanical Ventilation

Case Studies 625

to seek and follow medical advice through her primary care provider. She remained
on an oral steroid (Prednisone®) and an antibiotic (Erythromycin®) for an additional
10 days after discharge from the hospital.

NOTE: This case study on status asthmaticus describes the evaluative, diagnostic, and
ventilatory management techniques employed at the time it was first written. For additional
information on the treatment of asthma, please refer to the guidelines outlined by the
National Institute of Health (1997, Oct.). Practical guide for the diagnosis and management
of asthma. NIH Publication No. 97-4053. Additionally, asthma guidelines issued by the
NHLBI’s National Asthma Education and Prevention Program in 2007 should be consulted.
It has also been shown that people who are allergic to certain foods are also likely to have
asthma. Information can be obtained from the National Institute of Allergy and Infectious
Diseases; Dec. 2010, 126(6), p. s1–58.

CASE 3: POST-ABDOMINAL SURGERY

INTRODuCTION

C.T., a 78-year-old, 90-Kg, 5'4" female, was admitted to the emergency room (ER)
Leukocytosis (cWBC) is
generally caused by infection with complaints of the following ailments that had persisted for the past several days:
and is usually transient. It may abdominal pain, nausea, fatigue, weakness, shortness of breath, decreased exercise
also occur after hemorrhage.
tolerance, vomiting, and black tarry stools.
C.T. had a history of steroid-dependent asthma, COPD, coronary artery dis-
ease, diabetes, and arthritis. Her medications at home included Lasix, Diabeta,
Low hematocrit leads
to tissue hypoxia and it may nitroglycerin, aspirin, Prozac, potassium, Proventil, Intal, Azmacort, and oxygen at
account for her symptoms of
shortness of breath, fatigue, 2 to 3 L/min.
weakness, and decreased In the ER her abdominal exam revealed severe pain in all quadrants and her ab-
exercise tolerance.
dominal radiograph showed free air in all areas. Respiratory assessments showed
severe peripheral cyanosis, spontaneous respiratory frequency 32/min, heart rate
120/min, decreased breath sounds in all lobes with fine inspiratory crackles in
Diabeta (glyburide) is
used to treat type 2 diabetes the lower lobes, and accessory muscle use during inspiration.
(condition in which the body
does not use insulin normally Laboratory studies were done upon admission with the following results:
3
3
and therefore cannot control WBC 22.2 3 10 (normal 3.2 to 9.8 3 10 ), hematocrit (Hct) 25% (female
the amount of sugar in the 3 3
blood). average 42%), platelets 34.2 3 10 (normal 130 to 400 3 10 ). The electro-
cardiograph (ECG) showed sinus tachycardia with nonspecific ST and T wave
changes.
Other medical history was not significant. The patient’s last hospitalization
Thrombocytopenia
(Tplatelets) occurs in acute was 3 years ago for asthma. Upon discharge from the hospital, her room air
infections, anaphylactic blood gases were pH 7.43, PaCO 50 mm Hg, PaO 42 mm Hg, HCO
-
shock, and some hemorrhagic 2 2 3
diseases and anemias. 32 mEq/L, and SaO 77%. She was prescribed home oxygen therapy at
2
that time.

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