A 28-year-old male has arrived in the emergency department following a motor vehicle accident. He has a Glasgow Coma Score of 14. Chest X-ray reveals five ribs broken anteriorly in two areas each

Question

Physical assessment reveals paradoxical movement of the chest. Breath sounds are diminished and the trachea is midline. Arterial blood gas on nonrebreather mask is: pH 7.53, partial pressure of carbon dioxide (PaCO2) is 25 mm Hg, partial pressure of oxygen (PaO2) is 59 mm Hg, arterial oxygen saturation (SaO2) 93%, bicarbonate (HCO3?) 23 mEq/L. The respiratory therapist should recommend which of the following for this patient?
a. Noninvasive positive pressure ventilation (NIV) with supplemental oxygen
b. Intubation with volume-controlled con-tinuous mandatory ventilation (VC-CMV) with positive end-expiratory pressure (PEEP)
c. Mask continuous positive airway pressure (CPAP) with supplemental oxygen
d. Intubation with CPAP and pressure sup-port

Answer 1

ANS: C
The arterial blood gas shows that the patient is ventilating, as evidenced by the partial pressure of carbon dioxide (PaCO2) of 25 mm Hg. Therefore, this patient does not need to be intubated and ventilated at this time. This also means that the patient does not require noninvasive positive pressure ventilation (NIV). The patient does have an oxygenation problem, as evidenced by the partial pressure of oxygen (PaO2) of 59 mm Hg while on a nonrebreather mask. This is an indica-tion for continuous positive airway pressure (CPAP).