doyoudig
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Two days after a cholecystectomy, a 42-year-old woman has shortness of breath. Her temperature is 37.5 C (99.5 F), blood pressure is 110/70 mm Hg, pulse is 103/min, and respirations are 24/min. There is abdominal tenderness. Examination shows no other abnormalities. An x-ray film of the chest shows minimal linear markings in the right lower lobe. Arterial blood gas analysis on 45% oxygen shows:
pH 7.41
PCO2 40 mm Hg
PO2 52 mm Hg
Which of the following is the most likely explanation for her hypoxia?
A ) Acute respiratory distress syndrome
B ) Atelectasis
C ) Congestive heart failure
D ) Fat embolism syndrome
E ) Pneumonia
F ) Pneumothorax
How can you differentiate btw them?? Can you explain it from the question above as well as other differentiatinf features?
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| doc_clotaire
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B
Atelectasis : collapse of part of entire lung most commonly seen in Post -operative period secondary to poor inspiration or lack of coughing during this time
Pneumothorax : Air collection in pleural space that can lead to pulmonary collapse
Spontaneous Pneumotorax : look for tall , thin young dude most likely due to a rupture of subpleural blebs
Tension Pneumotorax : look for history of trauma , infection , CHF , due to air trapping into the pleural space that cannot get out . This one is a life theatening condition and your next step in management must be immediate needle decompresion
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| doyoudig
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doc_clotaire do you think that "minimal linear markings in the right lower " is more likley a Pneumothorax versus Atelectasis??
I was wondering that in Atelactasis it would be an Increased Markings" b/c of Colapse
what do you think? thx
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| mdwannabe
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it is B...with PTX there are NO lung markings beyond the point of collapse. Large, lobar atelectasis will cause disturbance in abatomical markings, but will retain the the marking around or beyond the collapse and will show the rest of the lung adherent to parietal pleura.
Also, look out for low grade fever, though in this case it may be secondary to post Sx.
Hypoxemia can be present in both. The larger the collapse the bigger the mismatch.
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| mdwannabe
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In atelectasis one shall see a line or patch that resembles an infiltrate, but the lung markings around it must extend all the way to the chest wall, with out interruptions, unless some pathology co-exists.
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| doyoudig
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thank you!!
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| Justice
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(B)
It is not discussed in the Q, but she might be given general anesthesia - hypoventilation - atelectasis
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| mdwannabe
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actually hypoventialtion will not cause the atelectatic changes. However, high O2 fraction would. In any case, general anestesia is not assiciated with atelectasis, rather post OP bed rest, pain in abdomen and ribs etc.
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