Pulmonary Problem Solving I

Scenario Five

Patient Chart
EA is a 31-year-old male who was transported to the ED by EMS after he was rescued from a house fire. He has only minor burns on his body; however, he does have a moderate amount of sooty residue around his mouth and nose. He is alert and anxious and has the following vital signs: respiratory rate 26. His SpO2 while breathing oxygen via nonrebreathing mask is 100% (using a standard pulse oximeter).

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

Twenty minutes after arrival in the ED, the following arterial blood gas data are obtained:
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 remains on the nonrebreathing mask. He is still alert and becoming less anxious.

Three hours later, his COHgb has decreased to 6.1% and he appears to be breathing comfortably. The nonrebreathing mask is replaced with a 40% Venturi mask. The decision is made to keep him in the 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 with the following results:
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: /


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