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CASE STUDY
Mr. P., a 23-year-old, presents to the emergency department and reports mild shortness of breath for "3 or 4 days." During the triage, he tells you that he works as a patient care technician on a medical-surgical floor. He denies any significant past medical or surgical history but remembers being short of breath during high school track practice. He does not smoke, but he does vape occasionally, three to five times per week.
During the physical examination, you find that he is afebrile, heart rate is 110, respiratory rate is 38 breaths/min, blood pressure is 138/90 mm Hg, and SpOâ‚‚ reads 93%. Upon chest inspection, you observe normal chest wall anatomy and normal skin color for race and age. The patient remains tachypneic during the exam, with rapid and shallow respirations. Upon lung auscultation, you hear soft, relatively low-pitched sounds over the top two-thirds of his lung fields bilaterally. In both lower lobes, you hear adventitious breath sounds that are deep, low-pitched rumblings. The sounds do not change when you ask the patient to cough.
The provider orders O₂ at 2L via nasal cannula, a complete blood count (CBC), an ABG, and a portable chest x-ray (CXR). ABG results are pH 7.51, PaO₂ 85 mm Hg, PaCO₂ 28 mm Hg, HCO₃ 26 mEq/L.
1. Describe the elements of the patient's history and vital signs that cause you the most concern.
2. Interpret the patient's ABG results, and explain the patient's hypocapnia (lower than normal COâ‚‚).
3. What, if any, are significant findings on the patient's physical examination?
