What was done to harry that caused the later Pco2 measurement to be normal? His pneumothorax was surgically corrected A cancerous tumor was removed from his lung He was given antibiotics He was given IV fluids to help correct his pH
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Case 49 A 48-year-old man had a long history of alcoholism and was admitted to the intensive care unit with profound hypotension and gastrointestinal bleeding. He was intubated and given intravenous fluids and transfused with packed red blood cells. He remained intubated and ventilator dependent for several weeks. He developed fevers and was treated with broad-spectrum antibiotics. Culture of his tracheal aspirate showed polymorphonuclear leukocytes and gram-negative rods. His chest radiograph was not mentioned.
Adi S.
The Car Accident: A Case Study in Acid-Base Balance Mr. Henderson, a 52-year-old male, was on his way to work during a heavy rainstorm when he lost control of his car and crossed into oncoming traffic where he collided head-on with a small delivery truck. Witnesses accessed the 911 emergency medical response system, and paramedics arrived quickly. The driver of the truck suffered only minor cuts and scrapes, but Mr. Henderson was having difficulty breathing and complaining of severe chest pain. Transport time to the nearest trauma center was less than two minutes, so the emergency personnel elected to "scoop and haul." A large bruise on his chest indicated that Mr. Henderson had experienced blunt trauma from the impact of the steering wheel after the airbag failed to deploy. Mr. Henderson presented in the ER with blurred vision, dizziness, headache, nausea, muscle weakness, hypoventilation, and a feeling of mental confusion. A chest X-ray revealed bilateral fractures in the fourth, fifth, and sixth ribs along with a suspected hemothorax. An ECG revealed signs of ventricular arrhythmias. The following values were taken from the results of an arterial blood gas (ABG) and urinalysis (UA) in the blood and urine tests. 3. Explain how Mr. Henderson's rib fractures are related to the suspected hemothorax. 4. Mr. Henderson's PCO2 is elevated. Under normal conditions, what would be the PRIMARY mechanism that his body would use to reduce the amount of PCO2 in the blood? Why is this mechanism not working in this case? 5. Describe how the high PCO2 and low pH in Mr. Henderson's blood are related in this case. 6. Describe how the high bicarbonate in Mr. Henderson's blood is related to the low pH in his urine. 7. What type of intervention might the doctors and nurses initiate in order to address the hemothorax? Explain how this intervention will lead to changes in PCO2 and blood pH.
A 20 year old male was working second shift when a 10-ton forklift fell and pinned him face down. He was trapped for 20 minutes. Paramedics at the scene started intravenous fluids. His vitals at the scene were heart rate 120 bpm (normal 60-100 bpm), blood pressure 90/70 mm Hg (normal 120/80 mm Hg) and respirations 46 breaths/min (normal 12-18 breaths/min). In the ambulance he continued to be tachycardic and he reported that his heart was "pounding in his chest". He was restless, pale, cool and damp. His vitals in the ambulance were heart rate 138bpm and blood pressure 88/70 mm Hg. Peripheral pulses and bowel sounds were absent. Intravenous fluids were continued and he was diagnosed as being in hypovolemic shock. At the hospital his initial hemoglobin was 9 g/dl (normal 12.4-14.9 gm/dl ) and hematocrit was 30% (normal 42%-54%). He was put oxygen at 3L/min by nasal cannula and a urinary catheter was inserted. Urine production was very low. After a transfusion of 2 units of red blood cells, his heart rate was 110 beat/min, blood pressure 102/70, and respirations 28 breaths/min. He complained of severe abdominal pain and abdominal lavage revealed excess peritoneal fluid containing red blood cells. He was then taken to the operating room for emergency treatment of a ruptured spleen. During the surgery he needed 6 more units (3 liters) of red blood cells. After the surgery he appeared to stabilize with vitals of heart rate 104, blood pressure 106/70, and respirations 26 breaths/min. He continued to recover over the next few days, during which time he had low urine output.
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