Question

A 32 yom in MVA-took 911 90 min. to extricate him from car. Speech incoherent.

On admission-hypotensive, consious, complaining of severe pain in whole body. Numerous facial lacerations and several broken teeth. A zygomatic arch was broken and his right maxilla was fractured. Compound fracture of left humerus, several phalanges fractured. A large bruise over anterior chest. Chest -xray showed no broken ribs, bilateral patchy infiltrates could be seen thoroughout both lungs.

Taken to surgery-16 hours. On arrival to ICU on nc at 2lpm. Cardiopulmonary status stable.

After 24 hours-signs of respiratory distress-a respiratory consult ordered.

Patient in moderate distress-RR 21 HR 93 BP 125/78

ABG on 3lpm nc--pH 7.51 CO2 29 HCO3 22 O2 68

Chest x-ray---ground glass appearance

What is your diagnosis?

48 hours later-pt. cyanotic. RR 30 BP 165/95 HR 110. Rectal temp. 38.8 C

BS-crackles ABG 7.56 PaOC2 24 HCO3 18 Os2 35 on 3lpm

No current chest -ray.

Now what is your treatment?

Now what is your diagnosis?

Answer 1

1. Ground glass apearance in both the lungs indicates inflammation and infiltration of lungs caused by accident. This needs to be continuously monitored by Chest X ray. Sometimes it may be transient.

2. Respiratory distress indicates primary respiratory alkalosis which is due to accident and anxiety, etc.There is decrease in CO2 in blood and imbalance occurs. So treatment to reduce the hyperventilation by coping with the situation, meditation, being calm etc.

48 hrs later;

X ray to check the lungs for GG appearance.

still the symptoms of hyperventilation and inflammation is present along with worsening respiratory acidosis and crackling sounds. So treatment includes Steroids, bronchodilators, Oxygen therapy and Pulmonary resuscitation.