BOF: 48
A 24-year-old male who is a known asthmatic is admitted
with severe breathlessness.
His PEFR is 200 l/min
Blood gases on air show pH 7.5, pO2 9kPa, pCO2
3.3 kPa and bicarbonate 11 mmol/L
The patient is treated with steroids, oxygen and inhaled
bronchodilators.
He is reassessed a short while later and his blood gases
show pH 7.27, pO2 8kPa, pCO2 6.4 kPa, bicarbonate 16
mmol/L
In this patient which of the following investigations
would you arrange next?
a)
Chest X-ray
b)
PEFR
c)
Urine toxicology screen
d)
Venous bicarbonate
e)
ECG
Answer: a)
The patient has acute severe asthma and has deteriorated
over a short period and is now hypoventilating.
The conditions that are likely to cause this are:
·
Pneumothorax
·
Pneumonia
·
Bronchial obstruction with collapsed lung
·
Patient exhaustion
·
Sedative drugs
Hence, the importance of a chest X-ray
Revision Tip
Revise acute severe asthma KEYS
to SUCCESS in Medicine page 185-186
