Respiratory Cases I

59 yo male, emergency dyspnea

Patient Chart
CS is a 59-year-old male who presents to the emergency department complaining of increased dyspnea that started recently. He has a five year history of COPD and is on oxygen at home via nasal cannula at 2 Lpm. Assessment reveals a slightly cachectic and underweight male in moderate respiratory distress. His heart rate is 100, respiratory rate is 34, temperature is 98.7o F. His SpO2 is 91% while breathing oxygen via nasal cannula at 2 Lpm. To complete the physical exam, use the Blood Pressure tab above to simulate taking the patient blood pressure and pulse rate. Then use the Auscultation tab to assess the lung sounds.

Twenty minutes after the patient received initial therapy, arterial blood is drawn for analysis with the following results:

pH: 7.29
PaO2: 59 mm
PaCO2: 72 mmHg
SaO2: 87
HCO3: 32 mEq
Hgb: 16.4 gm

Heart Rate:
Blood Pressure: /


Which of the following is the most likely diagnosis to make at this time?