Respiratory Cases II

61 yo female, dyspnea, productive cough

Patient Chart
CM is a 61-year-old female who is brought to the emergency department by her husband. She was complaining of dyspnea that has been increasing over the past several hours. She has a history of shortness of breath and productive cough. Included in her home medication regime are Advair and Spiriva. In triage, she has a pulse of 104, respiratory rate of 36, and temperature of 98.9o F. Her SpO2 is 84% while breathing room air. She has an occasional cough productive of small amounts of thick, pale yellow sputum.

Use the Auscultation and Blood Pressure tabs to capture heart rate, blood pressure and lung sounds.

Stat portable chest radiograph reveals essentially clear and darkened lung fields with flattened diaphragms and nearly ninety degree costophrenic angles. Arterial blood gases obtained while the patient was breathing oxygen via oxygen nasal cannula at 2 Lpm show the following data:

pH 7.27
PaCO2 74 mmHg
HCO3 34 mEq
PaO2 59 mmHg
SaO2 87%
Hgb 16.6

Heart Rate:
Blood Pressure: /


Which of the following is the most likely diagnosis for this patient?