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Second Opinion on Diagnosis
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Second Opinion on Diagnosis

I hope you can help us.  My son is working on a case study for his AP II class and we are not having great success in finding information on the internet.  For this case study, my son is the doctor of a 22 year old man who was injured in a motorcycle accident.  The patient is complaining that his chest feels very heavy and it is hard to breathe.  His chest was x-rayed and a technician put some contraption on his face and asked him to breathe.  It is hard to do.  They also take some blood.

The following info was provided next:

X-rays indicate neck injuries led to partial paralysis of the upper & lower limbs.  Almost immediately patient became dyspneic.  His pulmonary functions values were:

Vital capacity (supine) = 650 ml
Minute respiration (supine) = 6 L/min
Respiratory rate (supine) = 30 b/min
PaO2 61 mm Hg
PaCO2 47 mm Hg

Finally, my son was asked:
1) What is the diagnosis for this individual?
2) What is contributing to the decreased vital capacity?
3) Which nerves and muscles are involved in this problem?
4) Define dyspnea.
5) What is causing the dyspnea in this individual?
6) Define tachypnea.
7) Describe the reflexes involved in causing the tachypnea in this individual.

We've come up with a few scenarios, but primarily feel there is neck injury in the area of the MO.  He feels there is also damage to the Vagus (X) nerve which would hamper the diaphragm.  Some of his classmates have come up with other versions.  These kids have been told they can find the necessary answers through any source they choose.  Please, can you help us?

Thank you.
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I suggest that this student go to the nearest medical library.  Look to a textbook on pulmonary disease and request to do a Medline Search. He should then search the following: diaphragmatic paralysis, vagus nerve interruption, cervical spine injuries, restrictive lung disease and lung contusion.
The key findings below are the low blood oxygen (PaO2), the high blood carbon dioxide (PaCO2) and the markedly abnormal pulmonary function values.  The low vital capacity makes it most likely that both sides of the diaphragm have been paralyzed along with the smaller chest muscles used for breathing.  Nerves from the spinal cord control these muscles.  The neck injuries that led to the partial paralysis of his limbs must have also injured these nerves.  The motorcycle accident may have also injured the vagus nerve.  This nerve also controls the diaphragm but from the brain stem.
The paralyzed muscles will cause this 22-year-old man to feel short of breath.  Feeling short of breath is also called dyspnea.  The paralyzed muscles are also keeping this 22-year-old man from taking in more air with each breath so the only way that he can get more air into his lungs is to breath faster.  Breathing faster is also called tachypnea.
Hope this helps.
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