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

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.

Did this patient demonstrate any of the pathophysiologic alterations associated with ARDS?

Did this patient have risk factors associated with ARDS?

Answer 1

1. Patient did demonstrate pathophysiologic alteration associated with ARDS. Though the cardiopulmonary status is stable the bilateral patch infiltrates could be seen throughout both the lungs and the ground glass appearance in the chest x-ray demonstrate the pathophysiological alteration of ARDS.

2. The patient has risk factors associated with ARDS- Though the respiration rate,heart rate, BP seem to be in normal ranges after 24-hours, changes were noticed 48 hours later. After 48 hours patient exhibited the symptoms of being cyanotic with increased RR(respiration rate),BP(blood pressure) and HR which show that the patient had risk factors associated with ARDS.