Pulmonary Problem Solving I

Scenario One

Patient Chart
KB is a 26-year-old male who was involved in a car crash two years ago. The crash caused his spinal cord to be severed at the level of C3.

Following the crash, KB spent three weeks in the acute care hospital. After his condition stabilized, he was transferred to a rehabilitation facility for three months. He currently resides in a long-term care facility that specializes in quadriplegic care. He has a #8 cuffed tracheostomy tube with an inner cannula. Throughout the day, the cuff is kept mostly deflated so he can vocalize. He is on a portable ventilator with the following settings:

Mode: volume control - assist/control
Rate: 14 breaths per minute
Tidal volume: 650 mL
FiO2: .21

He has been maintained on these settings for the past several months without incident.

Over the past 24 hours, KB’s condition seems to have changed. In particular, he is complaining of dyspnea. His pulse has increased to 102 and his temperature is 101.3F. His SpO2 on room air is 88%. His caregiver reports that she has been suctioning him for moderate amounts of thick, dark yellow sputum.

Heart Rate:
Blood Pressure: /


Which of the following is KB’s most likely diagnosis?