Question

Case Scenario: A patient has been brought to the ED with the following symptoms: (a) reports feeling sick, (b) weak, (c) cold at times and hot others, (d) nauseated, (e) confused and at times afraid, without a specific reason why, (f) thirsty, and (g) short of breath. Nothing in his history gives clear direction of what might be happening. His blood gases reveal respiratory alkalosis. Vital signs are HR 95 RR 40 BP 100/60. The doctor states the patient exhibits shock symptoms.

1. Question: What history would you see as beneficial to treating this patient? You will need to defend your answer using specific facts, data, and other information drawn from the textbook and at least one other supplemental source.

Answer 1

According to the case scenario, patient have

BP 100/60 mmHg

Heart rate 95 beats/min

Respiratory rate 40/min

Patient is having respiratory alkalosis which implies that his blood pH is more than 7.4 (normal pH of blood is 7.4)

Also patient is thirsty, confused and cold.

The doctor says that patient is in shock.

Looking in symptoms and signs if patient and after given clinical examination, patient is in shock.

Patient is having BP 100/60 mmHg which is cut off limit for diagnosing shock. According to Harrison's textbook of internal medicine, isolated systolic BP of </=90 or isolated BP of </=60 is diagnosed as shock. This will be the most important fact which will make the treatment of shock beneficial in this patient. Also patient is cold, clammy, confused and thirsty which will again point towards the diagnosis of shock. Decreased blood volume will trigger the thirst centres present in brain which will signal the person to drink water(thirst). Also decreased blood volume will decrease the blood supply to the periphery( cold and clammy extremities) and increase it in central systems such as Central nervos system, cardiovascular systems etc. Decreased blood pressure will increase the heart rate above its normal range( 60-90beats/min) through sympathetic stimulation.

Respiratory rate is 40/min which increased than the normal range (12 to 16/min in adult) which will lead to respiratory alkalosis due to excess carbon dioxide washout.

Hence above mentioned history will be beneficial in treating the patient as directed by the doctor.