Respiratory Cases I


25 yo male fire victim


Patient Chart
WN is a 25-year-old male transported to the emergency department via local EMS after he was rescued from a fire in his garage. He appears to have suffered minor burns to his body; however, he does have a moderate amount of sooty residue around his mouth and nose. He is alert and oriented but anxious. His heart rate is 106, respiratory rate is 28. His SpO2 is 100% while receiving oxygen via nonrebreathing mask.

Use the Blood Pressure and Auscultation tabs to complete the physical assessment.


Twenty minutes after arrival initial therapy, arterial blood gas data are obtained with the following results:
pH: 7.48
PaO2: 210 mmHg
PaCO2: 28 mmHg
SaO2: 89%
HCO3: 21 mEq
Hgb: 14.2 gms
COHgb: 10.4%

Because of the presence of carbon monoxide on the hemoglobin, the patient continues to receive oxygen via nonrebreathing mask. He is still alert; his anxiety is gradually lessening.

Three hours later, his COHgb has decreased to 6.1% and he is breathing comfortably. The nonrebreathing mask is replaced with a 40% Venturi (air entrainment) mask. He remains in ED for observation.

Six hours after admission, his respirations become more rapid and labored. Auscultation reveals fine crackles throughout both lungs. A portable chest film shows bilateral infiltrates extending into all four lung quadrants. Arterial blood is again drawn:
pH: 7.37
PaO2: 66 mmHg
PaCO2: 38 mmHg
SaO2: 88%
HCO3: 21 mEq
COHgb: 3.9%
FiO2: 40% (Venturi mask)

Heart Rate:
Blood Pressure: /

Auscultation:




Diagnosis
At this point, the patient is most likely developing which of the following?