Pulmonary Problem Solving II


Scenario Four


Patient Chart
AC is a 65-year-old male presents to the emergency department complaining of severe dyspnea. He has a history of shortness of breath. His home medications include Spiriva and Symbicort. He has a respiratory rate of 38, and temperature of 99.1o F. His SpO2 on room air is 84%. He 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 film shows basically clear lung fields with flattened diaphragms. Arterial blood gas results (drawn while the patient was breathing oxygen via nasal cannula at 2 Lpm):

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

Heart Rate:
Blood Pressure: /

Auscultation:




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