A 68-year-old, non-smoking female presented to the Emergency Room for evaluation of dyspnea (shortness of breath)...

 

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A 68-year-old, non-smoking female presented to the Emergency Room for evaluation of dyspnea (shortness of breath) of 1-hour duration. On examination, her vital signs were: temperature of 98.8°F; pulse of 90 beats/minute; respiratory rate of 20 breaths/ minute; and weight of 140 lbs. In addition, lung sounds were clear (without wheezes or dullness). She indicated that she had been feeling unwell for over three days and that several of her family members had been coughing. She also indicated that she had self medicated on Bactrim, a sulfonamide antibiotic that her much younger sister had been prescribed. Initial arterial blood gas analysis indicated a pH of 7.50; P of 96 mm Hg: P co of 25 mm Hg; bicarbonate level of 24mmol/L; and oxygen saturation (SpO,) of 88%. The patient's labored breathing subsequently worsened. The patient's pulse oximetry (SpO) reading worsened to 86% and did not increase after the patient was given oxygen by nasal cannula. A pulse oximetry reading measures oxygen levels in oxygenated blood; a healthy person normally has a value of 98-100%. Blood drawn from the patient's left arm (from a vein) was chocolate colored. In a healthy individual, such blood is dark red. A second blood sample was drawn from the radial artery. Blood gas analysis revealed a methemoglobin level of 23%, a level that is way above the normal (of about 1%). This is consistent with the original findings and the lack of response to oxygen therapy. Oxygen therapy was continued and methylene blue (1 mg/kg) was co-administered. Pulse oximetry readings indicated that Spo, improved to approximately 89%. Approximately 5 minutes after the first dose, another 1 mg/k dose of methylene blue was given and the Spo, improved to 92%. The patient was moved to the ward and, after two uneventful days, was discharged. She was provided with an inhaler containing a bronchodilator and instructed in its use. She was asked to use it in case of onset of renewed shortness of breath. She was cautioned to stop taking additional Bactrim and any prescription medication not specifically prescribed for her. She was also asked to follow up with her private physician. A 68-year-old, non-smoking female presented to the Emergency Room for evaluation of dyspnea (shortness of breath) of 1-hour duration. On examination, her vital signs were: temperature of 98.8°F; pulse of 90 beats/minute; respiratory rate of 20 breaths/ minute; and weight of 140 lbs. In addition, lung sounds were clear (without wheezes or dullness). She indicated that she had been feeling unwell for over three days and that several of her family members had been coughing. She also indicated that she had self medicated on Bactrim, a sulfonamide antibiotic that her much younger sister had been prescribed. Initial arterial blood gas analysis indicated a pH of 7.50; P of 96 mm Hg: P co of 25 mm Hg; bicarbonate level of 24mmol/L; and oxygen saturation (SpO,) of 88%. The patient's labored breathing subsequently worsened. The patient's pulse oximetry (SpO) reading worsened to 86% and did not increase after the patient was given oxygen by nasal cannula. A pulse oximetry reading measures oxygen levels in oxygenated blood; a healthy person normally has a value of 98-100%. Blood drawn from the patient's left arm (from a vein) was chocolate colored. In a healthy individual, such blood is dark red. A second blood sample was drawn from the radial artery. Blood gas analysis revealed a methemoglobin level of 23%, a level that is way above the normal (of about 1%). This is consistent with the original findings and the lack of response to oxygen therapy. Oxygen therapy was continued and methylene blue (1 mg/kg) was co-administered. Pulse oximetry readings indicated that Spo, improved to approximately 89%. Approximately 5 minutes after the first dose, another 1 mg/k dose of methylene blue was given and the Spo, improved to 92%. The patient was moved to the ward and, after two uneventful days, was discharged. She was provided with an inhaler containing a bronchodilator and instructed in its use. She was asked to use it in case of onset of renewed shortness of breath. She was cautioned to stop taking additional Bactrim and any prescription medication not specifically prescribed for her. She was also asked to follow up with her private physician.

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The patient was not responding to the oxygen therapy initially because patients SpO2 was 86 which is ... View the full answer