What would you do in such a situation?

[DarkProtonics]

Hypothetical situation: How would you manage such a pt:

Symptoms: 39.5 degC fever, BP 90/60, HR 120, productive cough, abdominal pain and distension, itchy rash, and tachypnea

Labs:
ABG:
FIO2: 21%
PaO2: 8.00 kPa
PaCO2: 6.67 KPa
pH: 7.20
SaO2: 85%
A-a gradient: 3.60 kPa
Shunt fraction: 24%
Std Base Excess: -7.9 mmol/L
HCO3: 19.3 mmol/L
CBC:
RBCs within reference ranges, but WBC count well above upper limit
CRP: 250 mg/dL
Sputum culture: positive for S. stercoralis
Lung biopsy: inflammation, edema, atelectasis, S. stercoralis, and eosinophils
Imaging:
Thoracic HRCT: pulmonary inflammation and edema

Would you oder a VBG to give you more info about the pt's oxygen requirements? Would you put the pt on PL-APRV, dexamethasone, and ivermectin? Has something similar ever happened in RL?

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[bigdan]

Can we have a bit more info?

Are those kiloPascals?

What's the ABG using mmHg for the gases? What's the H/H? Is the low BP new? Is this pt in the hospital, or just walking in the door?

Knowing nothing else, I'd get the pt some more O2, get some vascular access, and start some fluids.

Is this from a book? Is RL = real life?

dc

 

[howelljolly]

treat the patient... not the labs...

 

[proman]

This sounds like a homework assignment.

 

[southerndoc]

This sounds like a homework assignment.

Are you volunteering to grade the assignment?

 

[DarkProtonics]

Can we have a bit more info?

Are those kiloPascals?

What's the ABG using mmHg for the gases? What's the H/H? Is the low BP new? Is this pt in the hospital, or just walking in the door?

Knowing nothing else, I'd get the pt some more O2, get some vascular access, and start some fluids.

Is this from a book? Is RL = real life?

dc

Yes, those are kiloPascals. The BP is new...the pt was stable for a couple hours after she got admitted from the ED to the general wards for observation after coming in w/ a extremely bad cough one day.

Refresh me on what's H/H again.

I made this up.

 

[DarkProtonics]

treat the patient... not the labs...

The pt is unconscious...she passed out due to the low CaO2 --15.83%-- and low BP.

Her Hct is 40% and her Hb is 13.33 g/dL. Her BUN is 30 mg/dL and her serum creatinine is 3.0 mg/dL. Her estimated Cr clearance is 31.4 mL/min, based on her height of 6' 0" and her weight of 175 lbs.

 

[HomerSD]

Excuse my rudeness, but why these recurrent strange posts? The clinical scenario is oddly phrased, missing significant information, and the questions posed to us are outright from left field. Who interprets a ABG with pO2 and pCO2 in kPa? We get a shunt fraction, but no chem, no gap, and no lactate. The sputum culture is reportedly positive for Strongylodies, but no other cultures in a clearly septic patient.

I recall the poster admitting he's a community college student with an interest in medicine. If I'm right, I would recommend worrying about getting into medical school than posting these peculiar clinical scenarios.

 

[howelljolly]

The pt is unconscious...she passed out due to the low CaO2 --15.83%-- and low BP.

Her Hct is 40% and her Hb is 13.33 g/dL. Her BUN is 30 mg/dL and her serum creatinine is 3.0 mg/dL. Her estimated Cr clearance is 31.4 mL/min, based on her height of 6' 0" and her weight of 175 lbs.

Whut?

 

[bigdan]

Yes, those are kiloPascals.

I had assumed so. We (or at least I) don't tend to see ABGs in kPa; they tend to come in mm Hg. It'd be like me giving you a pt's weight in stone instead of kg or lbs.

I think what most of us are getting at is that it's hard to deal with your inital post, given that many of the main points of information are either indecipherable or absent, and that they presentation you offer is a bit incongruent. I know you mentioned you made it up, and I think that was kinda obvious from the start.

H/H is a shorthand I use for "Hemoglobin and Hematocrit".

Sorry for the lack of responses you're getting, but to even the minimally trained eye, your initial post is confusing and difficult to make use of.

Best,

dc

 

[howelljolly]

yes, those are kilopascals. The bp is new...the pt was stable for a couple hours after she got admitted from the ed to the general wards for observation after coming in w/ a extremely bad cough one day.

Refresh me on what's h/h again.

i made this up.

whut?

 

[leviathan]

whut?

Yeah....never seen an ABG reported in kPa before...

 

[MAC10]

ok ill amuse u since no one else on here will.

What would I do...ABC...give her some oxygen..then she needs resuscitation... fluids (need more info to tell u what type), blood (?h/h), if/and/ or whatever blood products as needed. I always found following a lactic acid level helpful with guiding fluids. I would also throw in some invasive monitoring aline, cvp just cause I can...naw really. Next on my agenda would be killing the bug (hope you got some sensitivites with that culture). Also would be interested in a blood culture. Then back to eating doughnuts.

 

[howelljolly]

mmmm... doughnuts

 

[DarkProtonics]

ok ill amuse u since no one else on here will.

What would I do...ABC...give her some oxygen..then she needs resuscitation... fluids (need more info to tell u what type), blood (?h/h), if/and/ or whatever blood products as needed. I always found following a lactic acid level helpful with guiding fluids. I would also throw in some invasive monitoring aline, cvp just cause I can...naw really. Next on my agenda would be killing the bug (hope you got some sensitivites with that culture). Also would be interested in a blood culture. Then back to eating doughnuts.

That's the answer I'm looking for.

 

[MAC10]

That's the answer I'm looking for.

What What..Raise the roof I thought the LUNG BIOPSY was a bit overkill though.

And in this case a VBG will only help me if we run out of toilet paper and im left with no option.

 

[souljah1]

Would you oder a VBG to give you more info about the pt's oxygen requirements? Would you put the pt on PL-APRV, dexamethasone, and ivermectin? Has something similar ever happened in RL?

Why would you look at a VBG to assess oxygen requirements? You have a pulse ox telling you that you're 85% on RA w/ evidence of an A-a gradient likely 2/2 worms.

Why would you put a patient with mild hypoxia on APRV?

 

[DarkProtonics]

Why would you look at a VBG to assess oxygen requirements? You have a pulse ox telling you that you're 85% on RA w/ evidence of an A-a gradient likely 2/2 worms.

Why would you put a patient with mild hypoxia on APRV?

Well, okay...perhaps BiPAP via a face-mask is a better alternative.

 

[Trifling Jester]

Would you oder a VBG to give you more info about the pt's oxygen requirements? Would you put the pt on PL-APRV, dexamethasone, and ivermectin? Has something similar ever happened in RL?

I'll humor you, even though I think you're having a laugh at all of us with these strange clinical scenarios and theories you've posted on the different boards.

No, I would not order a VBG, as I already have an ABG. PL-APRV? You mean intubate? I'd have to have the ABG reported in proper units, and know a little bit more about how the patient "looks" to give you an answer for that one.

Edit - In your subsequent posts on this thread you first say you would have her intubated. Then you say that she's unconscious (due to low caO2??) but you'd use BiPAP via facemask? Statements like that make me a little confused, and also a little skeptical.

As for dex and ivermectin, I'd probably just do whatever Sanford says and consider getting an ID consult.

And what exactly are you asking about when you say "has this ever happened in RL?" A strongyloides infection?

-The Trifling Jester

 

[DarkProtonics]

I'll humor you, even though I think you're having a laugh at all of us with these strange clinical scenarios and theories you've posted on the different boards.

No, I would not order a VBG, as I already have an ABG. PL-APRV? You mean intubate? I'd have to have the ABG reported in proper units, and know a little bit more about how the patient "looks" to give you an answer for that one.

Edit - In your subsequent posts on this thread you first say you would have her intubated. Then you say that she's unconscious (due to low caO2??) but you'd use BiPAP via facemask? Statements like that make me a little confused, and also a little skeptical.

As for dex and ivermectin, I'd probably just do whatever Sanford says and consider getting an ID consult.

And what exactly are you asking about when you say "has this ever happened in RL?" A strongyloides infection?

-The Trifling Jester

I meant by that statement that intubation may not be necessary.

I use the metric system to be consistent.

 

[howelljolly]

consistent with what?

 

[souljah1]

consistent with what?

consistent with pre-medicine

 

[Denial]

I meant by that statement that intubation may not be necessary.

I use the metric system to be consistent.

how can you use BiPaP on an unconscious patient?
patient is unconscious , I would entubate to protect airway and what is the abg again?

 

[aphistis]

how can you use BiPaP on an unconscious patient?
patient is unconscious , I would entubate to protect airway and what is the abg again?

According to the OP, pO2 is 18 kilomarmots, pCO2 is three half-inflated Wal-Mart grocery bags.