Page 669 - Clinical Application of Mechanical Ventilation

Case Studies 635

Complications

The patient experienced no lasting complications from his injuries. He was weaned
to room air and discharged from the hospital after day-6 postextubation.

CASE 6: DRUG OVERDOSE

INTRODuCTION

K.L. was a 78-year-old white male, 5 ft 8 in., medium build, who weighed about
73-Kg (160 lb). Upon admission to the 200-bed community hospital, his spontane-
ous frequency was 6/min and shallow. His skin color was pale but showed no
cyanosis.
The paramedics stated that the patient was found by his neighbors in the bath-
room lying on his back next to a pool of vomitus. The neighbors told the paramed-
ics that the patient had a history of asthma and that he had been depressed since
his girlfriend left him 2 weeks ago. An albuterol inhaler was found next to the pa-
tient and two empty bottles of tricyclic antidepressants were found on the kitchen
table. Additional medical history revealed that the patient smoked about one pack
of cigarettes each day.
The paramedics used a bag/mask resuscitator to ventilate the patient with O
2
at a frequency of about 20/min. They suctioned and removed large amounts of
vomitus from his airway en route to the hospital.
Upon arrival at the emergency room, the respiratory therapist provided bag/
mask ventilation. A nasogastric tube was inserted to prevent gastric distention and
aspiration.
Cardiopulmonary assessments provided the following information: heart rate
45/min, weak pulses, systolic blood pressure 90 mm Hg, SpO 90%, spontaneous
2
Blood gases show acute frequency 8/min, and shallow breath sounds with crackles and wheezes bilaterally.
ventilatory failure with
moderate hypoxemia. Arterial blood gases on 100% O revealed: pH 7.08, PaCO 70 mm Hg,
2
2
-
PaO 54 mm Hg, SaO 85%, and HCO 20 mEq/L.
2
2
3
Indications
The patient was intubated with a size 8.0 endotracheal (ET) tube. After checking
An end-tidal CO 2 reading for bilateral breath sounds, the ET tube was secured at the 24 cm mark at the lips.
of 20 mm Hg suggests correct
placement of the ET tube in The end-tidal CO reading was 20 mm Hg. During intubation, large amounts of
2
the trachea. watery brown secretions were suctioned from the airway and a sample was collected
and sent to the laboratory for analysis.
After the ET tube cuff was properly inflated, activated charcoal was put into the
stomach via the nasogastric tube in order to absorb the remaining tricyclics.

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