Question

In the emergency room the patient was febrile, cyanotic, and in obvious respiratory distress. He appeared malnourished at 6-ft tall and weighed 66 kg (146 lb). His skin was cool and clammy. The patient said, “I’m so short of breath!” His vital signs were as follows: blood pressure 154/110, heart rate 95 bpm, respiratory rate 25/minute, and oral temperature 38.3C (101F). He was using his accessory muscles of inspiration and breathing through pursed lips. An increased anteroposterior diameter of the chest was easily visible. Percussion revealed that he had low-lying, poorly mobile diaphragm. Expiration was prolonged, and his breath sounds were diminished. No wheezes were noted, but crackles could be heard over the right lower lobe. A chest x-ray showed hyperinflation, severe apical pleural scarring, a large bulla in the right middle lobe, and a right lower lobe infiltrate consistent with pneumonia (see the figure below). On instruction the patient’s forced cough was weak and productive of a small amount of yellow sputum. On 2 L per minute oxygen by nasal cannula, his ABGs were as follows: pH 7.59, PaCO2 40 mm Hg, HCO3 – 37 mEq/L, and PaO2 38 mm Hg. The physician ordered a pulmonary consult and stated that she did not want to commit the patient to a ventilator if possible. The patient also was started on intravenous doses of methylprednisolone.

What would you suggest I use as a treatment for this patient with emphysema?

Answer 1

Management for this patient is based on his symptoms.It is very important that respiratory supoort is neccessary to maintain the breathing pattern normal.Patient experincing most of the symptoms related to breathing difficulty.

• Oxygen therapy is needed .
• Bronchodilators
• Adequate antibiotic therapy is needed to treat emphysema.
• Mucolytics.
• Antipyretics.
• If neccessary use cpap or bi pap for supporting respiratory status.

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