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