Question

1. Define the following terms contained in this case:
   1. Bilateral

2. Hypoventilation

3. Hemothorax

4. Arrhythmias

2. What are the normal ranges for the measurements listed in the blood and urine tests? You may use your textbook to look these up.

3. Explain how Mr. Henderson’s rib fractures are related to the suspected hemothorax.

4. Mr. Henderson’s P_CO2 is elevated. Under normal conditions, what would be the PRIMARY mechanism that his body would use to reduce the amount of P_CO2 in the blood? Why is this mechanism not working in this case?

5. Describe how the high P_CO2 and low pH in Mr. Henderson’s blood are related in this case.

6. Describe how the high bicarbonate in Mr. Henderson’s blood is related to the low pH in his urine.

7. What type of intervention might the doctors and nurses initiate in order to address the hemothorax? Explain how this intervention will lead to changes in P_CO2 and blood pH.

Answer 1

1) Bilatral - means involving both side.

2) Hypoventilation - decresed Respiratory rater.

3) Hemothorax - Blood in the thoracic cavity

4) arrythmia - It is disorder of rhythm of the heart, in which heard beats in Irregular or abnormal rhythm.

CBC - normal range

Hb - 12-14 gm/dL

WBC - 4000-11000 /cmm

Platelet - 1.5 - 4.5 lack/cmm

Blunt trauma to chest wall may lead to rib fracture which may lead to accumulation of blood in the thoracic cavity i.e. Hemothorax.

Under normal conditions if PCO2 is Increased, patient hyperventilate to wash CO2 out to maintain the blood pH to normal level.

But in this case due to haemothorax lung tissue is collapsed due to accumulated blood in the thoracic cavity and hence hyperventilation alone will not be able to normalise the CO2.

High PCO2 will lead to Respiratory acidosis and hence pH will decrease.

In response to Respiratory acidosis kidneys tries to compensate by retaining bicarbonate and hence blood levels of bicarbonate is Increased.

Intercostal Drainage tube insertion is required to drain this blood out of the thorax / plerual space.

Intercostal drainge will reliese pressue on collapsed lung and hence lungs will expand and hence ventilation will ressume, and hence gradually PO2 and PCO2 will normalise