Treatment for low p02

[pallmall1]

I am a fairly new RN at an LTAC.  Called a rapid response for a patient with hx of renal failure and CHF.  Pt  was on the vent on A/C and became very lethargic with change in mental status.   Breath sounds on left were rhonchi and on right fine rhonchi and wheezing.  Her V/S were baseline tachy low 100s, sbp 140s, 02 96% at rate of 10, tv 450, peep of 5 (I think).  So we drew ABGs, CPP, did EKG.  P02 was 56.  Resp therapist nor SCU nurse were impressed by this and enjoyed many chuckles at my expense.  Was I wrong?  What could have been done for her?  Oh sorry, forgot to say CXR earlier that day showed developing infiltrates on right and elevated right hemidiaphram.

[David Tinkelman, M.D.]

In the circumstance you describe there are many possible causes of a reduction in p02, including but not limited to pulmonary infiltrates (pneumonia or heart failure or pulmonary emboli).   I can’t tell from your description whether the 96% 02 was an oximetry level or the inspired oxygen concentration.   If it is a saturation of 96% then there is a real discrepancy between that and the p02 of 56 that needs to be resolved.  Also don’t understand the reason for the “many chuckles” or what you were allegedly “wrong” about.

This is a confusing scenario and it should not be your responsibility to sort things out.  That responsibility should fall to the attending physician and you should urge your peers to arrange for that consultation.

Good luck

[Dr. Kokil Mathur]

Hi!
I am not sure what exactly was wrong but if she was having wheezes and ronchi then bronchodilators can be given to open up the airways. Also, she needed oxygen therapy, medical management of renal failure by probably dialysis. Blood urea, serum creatinine etc should have been measured. Apart from this, it is difficult to really analyze such cases on net. Please discuss with your seniors who were managing the case. Take care!

The medical advice given should not be considered a substitute for medical care provided by a doctor who can examine you. The advice may not be completely correct for you as the doctor cannot examine you and does not know your complete medical history. Hence this reply to your post should only be considered as a guiding line and you must consult your doctor at the earliest for your medical problem.