MEDICINEnotes

A 24-year-old man with known asthma presents with a severe exacerbation. On arrival, he is tachypneic and anxious. His initial ABG shows: pH 7.47 PaCO₂ 29 mmHg PaO₂ 72 mmHg One hour later, he appears quieter and his respiratory rate falls from 34 to 22/min. Repeat ABG shows: pH 7.35 PaCO₂ 44 mmHg PaO₂ 68 mmHg

A 20-year-old woman was diagnosed with asthma six months ago. At diagnosis, she had daily symptoms and frequent nocturnal awakening. She is now completely asymptomatic on low-intensity treatment.

A 28-year-old woman with known asthma has been using low-dose ICS-LABA for the last 3 months. She reports daytime symptoms on 4 days per week and occasional nocturnal awakening. She insists that she takes her medication regularly. Her prescriptions have been refilled on time.

A 28-year-old woman with asthma is prescribed low-dose ICS-LABA. She continues to experience symptoms four days per week. Her physician is considering increasing her inhaled corticosteroid dose. During review, she demonstrates that she does not shake her inhaler and actuates it after finishing inspiration.

A 22-year-old university student with known bronchial asthma reports symptoms only once or twice per month. He has no nocturnal symptoms and has never been hospitalized. He currently carries a salbutamol inhaler and uses it when needed.

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In a patient undergoing surgery, it was vital to aspirate the contents of the upper gastrointestinal tract. After the operation, the following values were acquired from an arterial blood sample: pH 7.55, PCO2 52 mm Hg and HCO3- 40 mmol/l.

A company driver is found at the scene of an automobile accident in a state of emotional distress. He tells the paramedics that he feels dizzy, tingling in his fingertips, and does not remember what happened to his car. Respiratory rate is rapid at 34/minute.

A patient who is hospitalized due to vomiting and a decreased level of consciousness displays slow and deep (Kussmaul breathing), and he is lethargic and irritable in response to stimulation. The doctor diagnosed him of having dehydration. Measurement of arterial blood gas shows pH 7.0, PaO2 90 mm Hg, PaCO2 22 mm Hg, and HCO3 14 mmol/L; other results are Na+ 120 mmol/L, K+ 2.5 mmol/L, and Cl- 95 mmol/L.