Patient Profile: Acute Hypercapnia Respiratory Failure secondary to OSA (obstuct

Patient Profile: Acute Hypercapnia Respiratory Failure secondary to OSA (obstuctive sleep apnea)
History: 56yr old Caucasian male history of obesity, OSA, diabetes, COPD, 20 pack year smoking history, denies drug or alcohol abuse, lives at home with wife, unemployed.
History of present illness:
5’7” male weighing 135kg brought in by EMS intubated after receiving a call from his wife that he was
found unresponsive. She stated he had complained of a headache, seemed slightly confused and “not himself” earlier that day. EMS stated patient was unresponsive, but still had a pulse, was intubated on scene with 8.0 tube, no complications.
Home medications include: insulin, albuterol, and has a CPAP that he has been noncompliant with.
Vitals stable at time of arrival. HR 89 SpO2 96% BP 117/77.
Patient placed on mechanical ventilation PRVC Vt 500 Rate 14 FIO2 70% Peep 8.
ABG after 1hr was ph 7.31 PaCo2 57 PaO2 216 HCO3 26.
Settings adjusted, rate increased to 18 and FIO2 decreased to 40% post ABG. Patient starting to
regain consciousness and was combative. Started on Propofol drip.
Chest X-ray showed endotracheal tube 3cm above carina and mild atelectasis, breath sounds
decreased with inspiratory crackles in the bases. Suctioning small amount of tan secretions. Patient
taken for CT of head and chest to rule out fall injuries after being found down. Patient admitted to ICU. CT results were negative for injuries.
After 1 day on ventilator patient ABG has normalized, patient was waking up and following commands
appropriately. Patient started on weaning trial. PS/CPAP FIO2 40% PS 10 peep 5. Patient passed weaning trial and was extubated.
Post extubation breath sounds diminished HR 92 SpO2 95% on 2l nasal cannula. Patient placed on
Duoneb QID, PEP therapy, and incentive spirometry post extubation, and a Cpap ordered HS, patient
educated on importance of continued CPAP use and smoking cessation.nula. Patient placed on
Duoneb QID, PEP therapy, and incentive spirometry post extubation, and a Cpap ordered HS, patient
educated on importance of continued CPAP use and smoking cessation.
*** topics should include Patient Profile and History, laboratrory tests and procedures, current medication, pathology of the disease, treatment plan, effectiveness of treatment, prognosis, summary and references( any amount is required)