Respiratory Case Study

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Respiratory Case Study

The following case study is of a 37-year old Hispanic male weighing 145 lbs and 70 inches tall found unconscious by his girlfriend. According to her he was unconscious for about 15 hours and she was concerned because he would not wake or respond and was breathing shallow and slow. She then called 9-1-1. The patient entered the ER by emergency vehicle and on my initial assessment Pt had an altered mental status, was very unresponsive showing symptoms of a possible drug overdose. The girlfriend told the physician the Pt had taken 75 mg of methadone and an unknown amount of Xanex and other amounts of Benzodiazepines. On assessment, the doctor noticed his altered mental status and unconscious status. He had a gag reflex and responded to pain. Pt had a blood pressure of 63/41 and a 02 saturation of 50% on room air and a heart rate of 108. We put the patient on an oxy mask at 14 liters and his saturation improved to 90%. The Physician then administered Narcan which in return raised the respiratory rate. The physician then eventually intubated with Etomidate. He is then diagnosed with Acute Renal Failure, Acute Lung Injury with possible aspiration and CHF with Atrial Fib.

The patient has had no prior history of drug overdose. The patient did, however, have a brother that recently committed suicide and was recently released from jail. The patient does drink alcohol and takes multiple street medications and methadone for pain.

For this patient with my initial thoughts would be to order an ABG to test for acidosis and see if there is an electrolyte imbalance, then a possible scan of the brain. An EKG test would also be ordered to see how the heart has dealt with the stress. Giving him Narcan would help block the receptor sites to stop the action of the OD. What ended up being ordered is the ABG, a CT of the brain, EKG, NG tube, Catheter, Glasgow Coma Scale, Chest X-ray and the lab drew blood. The ABG showed severe metabolic and...
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