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Saturday, June 5, 2010

Please help clue me in

Explain this:

Pt admitting ABG at 1500: ph 7.41, CO2 58, po2 72 on RA, HCO2 32

2300: Pt extremely lethargic, rr shallow and irregular, ls diminished, although no other signs of respiratory distress.

Dr order: ABG and decrease oxygen to 1lpm and do ABG in hour

ABG results at 0100: 7.29, co2 92, po2 82 on 1.5lpm, hco3 35

RT recommendation: bipap

DR. order: breathing treatment and send pt to critical care, another abg at 0300, and decrease oxygen to room air.

0300 abg drawn: ph 7.23, co2 102, po2 some how 108, hco3 37

RT recommendation: Bipap

Dr. order: continuous breathing treatment with compressed air then repeat abg.

Dr. called back 30 minutes later after talking with pulmonologist and ordered bipap.

So what the hell with all the breathing treatments? It was obvious oxygen wasn't causing his distress. It was obvious the breathing treatment wasn't curing it. So what the...??? And why did this otherwise good doctor delay using bipap so long for?

If there are any RT wizards, doctors, nurses, students, or housekeepers out there with a clue as to what this doctor was expecting, please clue me in.
Word of the day:Brook: To tolerate or endure, to withstand, bear or suffer

I will brook no inferences at doctors who write orders that make no sense


Glenna said...

Yeah, I'm with you. I don't get it either. A couple of hours on the Bipap could have gotten the pt over the hump immediately.

Yes, clearly the pt was a retainer but but a retainer in the 50's, not at 102...give me a break.

That pt could have so easily have been better by morning had your suggestion been taken in the first place.

Heidi said...

Albuterol turns around that CO2 ;)

Bipap smipap, It's I or E except after C and I don't know why we'd want to use it anyway, the patients on their way to meet the maker via a careless doctor's orders.

Glenna said...

I kept thinking about this and I think it's a good wakeup call for all of us reading it. The doctor obviously was looking at the numbers instead of looking at the patient. How many times do we do that? Well, alot, quite frankly. How many times do we get frantic calls from the floor from nurses panicked because their patients are satting in the 70's. We go up to find a normally breathing patient wondering what all the fuss is...and it's a sweaty probe or cold hands....It's a good lesson to remember that probes and numbers (first gas being 7.41) isn't the whole story, the numbers just hadn't caught up yet to the patient's real respiratory status as presented clinically. Treat the patient! We all heard it a million times in RT/RN/Med school.