Mrs. Beacon, an 80-year-old
female, is brought to the emergency room with recent onset of stupor. Her
family reports that she has been complaining of fatigue and has been going
downhill for some time with progressive withdrawal and somewhat paranoid behavior.
Diagnosis:
She was initially diagnosed with possible stroke because of lateralizing
neurological signs. Later, hypothyroidism and early myxedema coma was
diagnosed.
Presenting signs/symptoms:
Hyporeflexia on right side
(could be from previous stroke), heart rate was 55, temperature 96°F, skin was
dry, her hair was thinning and she had continued stupor. The ECG showed a sinus
bradycardia and low voltage.
Relevant lab values (assume all
other lab values are normal): Urinalysis revealed urinary tract infection, T3
and T4 normal, TSH elevated
Relevant diagnostic
tests: Chest x-ray shows enlarged heart.
In your review of this case,
please address the following questions. Please include at least 5
research articles and/or Web citations as references.
1. What are the etiology
and risk factors associated with this case?
2. What is the
pathophysiological basis for the signs/symptoms that are seen in this case?
Mr. Smith is
a 16 year old male. He was hit on the left upper leg in a slide tackle while he
was playing high school boys and girls soccer championship game.
He
arrived at the emergency room in stable condition. He had lacerations on
his face and c/o pain in his right upper leg. T 98, P 86, R 20, BP
138/88.
Laboratory
Values
Hb
14.5 gm/dl, Hct 42%; Chemistries-WNL
Diagnostic
Test
Chest
x-ray- normal; fracture of the right femur. ECG- normal sinus rhyme.
His fracture site is stabilized and
he is sent to the surgical unit. The next day, he becomes confused,
disoriented, and dyspnic, and has tachycardia and a temperature of 100 F.
Within an hour, he becomes diaphoretic and cyanotic. Blood gases are: pH
7.25, pCO2 56, HCO3 24, pO2 58.
Mr. Smith is suspected of having a
fat embolism and he is intubated and placed on mechanical ventilation: tidal volume
(TV) 1000 ml, intermittent mandatory ventilation (IMV) 6/min, positive
end-expiratory pressure (PEEP) 5 cm H20, and FIO2 50%. An hour later, his
pH is 7.54, pCO2 30, HCO3 25, pO2 94.5.
In
your review of this case, please address the following questions. Please
include at least 5 research articles and /or Web citations as references.
1.
What do his ABGs indicate?
2.
What is the pathophysiological basis for the signs/symptoms that are seen in
this case?
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