Carl Casill is a 75 year old male with chronic bronchitis has a barrel chest and cyanosis of the lips and fingers. His pulse oximeter reads 86% oxygenation on room air. His PaO2 is 54 mm Hg. His PaCO2 is 56 mm Hg.
He is put on low-flow oxygen but complains of shortness of breath. His wife turns the O2 up to 6 liters/ minute. He is found unresponsive, Respiratory Rate = 4 per minute, with a PaCO2 of 79 mm Hg and a blood pH of 7.2.
a. Analyze his ABGs: is the initial PaO2 high or low? PaCO2 high or low?
b. What happened to the pH? Why?
c. He went into a coma because of the change in oxygenation of his blood. Why would that trigger the mental status change and low RR (hint: consider his diagnosis and what drives his breathing) ?
d. What caused him to have a barrel chest?
e. Explain the mechanism of chronic bronchitis.