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6 Cards in this Set
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7.42 / 32 / 91 / 21
A. A 67 y.o. female has had a closed reduction of a leg fracture without incident. Four days post-op she experiences sudden onset of severe chest pain and dyspnea. B. A 21 y.o. healthy female in her 3rd trimester of pregnancy has an acutely broken ankle. She appears to be in severe pain and is very upset. C. A 55 y.o. male with a 10-year history of "heart failure" treated with diuretics regularly. He complains of slowly worsening dyspnea and a chest X-ray reveals a large right pleural effusion. D. a 19 y.o. male with a history of chronic persistent asthma has been in exacerbation for 1 week. His family states that he has not slept for 2 days and his breathing is getting worse. He is sitting upright on a stretcher, is diaphoretic, is using accessory muscle and has an interrupted speech pattern. E. A 34 y.o. female is found unconscious in her bedroom with several empty pill bottles (narcotics) on the nightstand. In the ED she is unresponsive with episodes of hypopneas and apneas. |
Chronic respiratory alkalosis
A-a gradient = 19 B. A 21 y.o. healthy female in her 3rd trimester of pregnancy has an acutely broken ankle. She appears to be in severe pain and is very upset. |
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7.54 / 26 / 48 / 22
A. A 67 y.o. female has had a closed reduction of a leg fracture without incident. Four days post-op she experiences sudden onset of severe chest pain and dyspnea. B. A 21 y.o. healthy female in her 3rd trimester of pregnancy has an acutely broken ankle. She appears to be in severe pain and is very upset. C. A 55 y.o. male with a 10-year history of "heart failure" treated with diuretics regularly. He complains of slowly worsening dyspnea and a chest X-ray reveals a large right pleural effusion. D. a 19 y.o. male with a history of chronic persistent asthma has been in exacerbation for 1 week. His family states that he has not slept for 2 days and his breathing is getting worse. He is sitting upright on a stretcher, is diaphoretic, is using accessory muscle and has an interrupted speech pattern. E. A 34 y.o. female is found unconscious in her bedroom with several empty pill bottles (narcotics) on the nightstand. In the ED she is unresponsive with episodes of hypopneas and apneas. |
Acute respiratory alkalosis
A-a gradient = 69.5 A. A 67 y.o. female has had a closed reduction of a leg fracture without incident. Four days post-op she experiences sudden onset of severe chest pain and dyspnea. |
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7.41 / 25 / 35 / 15
A. A 67 y.o. female has had a closed reduction of a leg fracture without incident. Four days post-op she experiences sudden onset of severe chest pain and dyspnea. B. A 21 y.o. healthy female in her 3rd trimester of pregnancy has an acutely broken ankle. She appears to be in severe pain and is very upset. C. A 55 y.o. male with a 10-year history of "heart failure" treated with diuretics regularly. He complains of slowly worsening dyspnea and a chest X-ray reveals a large right pleural effusion. D. a 19 y.o. male with a history of chronic persistent asthma has been in exacerbation for 1 week. His family states that he has not slept for 2 days and his breathing is getting worse. He is sitting upright on a stretcher, is diaphoretic, is using accessory muscle and has an interrupted speech pattern. E. A 34 y.o. female is found unconscious in her bedroom with several empty pill bottles (narcotics) on the nightstand. In the ED she is unresponsive with episodes of hypopneas and apneas. |
Chronic respiratory alkalosis
A-a gradient = 83.75 C. A 55 y.o. male with a 10-year history of "heart failure" treated with diuretics regularly. He complains of slowly worsening dyspnea and a chest X-ray reveals a large right pleural effusion. D. a 19 y.o. male with a history of chronic persistent asthma has been in exacerbation for 1 week. His family states that he has not slept for 2 days and his breathing is getting worse. He is sitting upright on a stretcher, is diaphoretic, is using accessory muscle and has an interrupted speech pattern. |
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7.10 / 65 / 62 / 20
A. A 67 y.o. female has had a closed reduction of a leg fracture without incident. Four days post-op she experiences sudden onset of severe chest pain and dyspnea. B. A 21 y.o. healthy female in her 3rd trimester of pregnancy has an acutely broken ankle. She appears to be in severe pain and is very upset. C. A 55 y.o. male with a 10-year history of "heart failure" treated with diuretics regularly. He complains of slowly worsening dyspnea and a chest X-ray reveals a large right pleural effusion. D. a 19 y.o. male with a history of chronic persistent asthma has been in exacerbation for 1 week. His family states that he has not slept for 2 days and his breathing is getting worse. He is sitting upright on a stretcher, is diaphoretic, is using accessory muscle and has an interrupted speech pattern. E. A 34 y.o. female is found unconscious in her bedroom with several empty pill bottles (narcotics) on the nightstand. In the ED she is unresponsive with episodes of hypopneas and apneas. |
Mixed respiratory acidosis
A-a gradient = 6.75 E. A 34 y.o. female is found unconscious in her bedroom with several empty pill bottles (narcotics) on the nightstand. In the ED she is unresponsive with episodes of hypopneas and apneas. |
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7.15 / 33 / 98 / 11
A. A 67 y.o. female has had a closed reduction of a leg fracture without incident. Four days post-op she experiences sudden onset of severe chest pain and dyspnea. B. A 21 y.o. healthy female in her 3rd trimester of pregnancy has an acutely broken ankle. She appears to be in severe pain and is very upset. C. A 55 y.o. male with a 10-year history of "heart failure" treated with diuretics regularly. He complains of slowly worsening dyspnea and a chest X-ray reveals a large right pleural effusion. D. a 19 y.o. male with a history of chronic persistent asthma has been in exacerbation for 1 week. His family states that he has not slept for 2 days and his breathing is getting worse. He is sitting upright on a stretcher, is diaphoretic, is using accessory muscle and has an interrupted speech pattern. E. A 34 y.o. female is found unconscious in her bedroom with several empty pill bottles (narcotics) on the nightstand. In the ED she is unresponsive with episodes of hypopneas and apneas. |
Metabolic acidosis
A-a gradient = 10.75 None of the above |
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If the patient is hypercapnic with a normal A-a gradient, what do you think?
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The problem is with HYPOVENTILATION, not with the lungs.
If someone has lung disease, they may hypoventilate, but they will never have a normal A-a gradient. |
