me007
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a 45 yo women undergoes cholecystectomy for a gangrenous gallbladder.
On day4 postop, the pt complains of chest pain on right side, which incr on inspiration.
Blood analysis- incr pH, decr pO2.
On day 7 pt dies
Which of the following the best explains decr in art pO2 on day 4?
1. diffusion defect
2. perfusion defect
3. resp acidosis
4. resp alkalosis
5. ventilation defect
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| new_n_lost
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5. ventilation defect <== ARDS ???
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| keepgoing
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interesting ...yes i think vent defect b/c other most likely option wud be resp acidosis but its outcome so vent defect--mechanism....should be the right answer..
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| afrocaribb
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its definately a ventilation defect, this occurs because after surgery patients are scared to take deep breaths because of fear of pain and so when u dont take in enuf air ur alveolars will collapse and thats why u always tell them to take in deep breaths.....
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| virgola82
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Correct me if I'm wrong but shuldn't a ventilation defect lead to hypercapnic resp failure? So it couldn't explain the high pH value. I was actually thinking of a PE (option #2). It should lead to V/Q alteration and so low pO2 and compensatory hyperventilation that could in turn increase the pH.
What do you think?
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| new_n_lost
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Sepsis --> DIC --> ARDS ?? Y PE ??
Plz Elaborate
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| Luckyall
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this pt has atelectasis post surgery, not ARDS
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| Luckyall
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so there is Perfusion with NO ventilation, but is post Surgery Atelectasis, not ARDS
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| me007
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The MCC of fever within 24-36 h after surgery is atelectasis.
not in this case
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| me007
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but there is a perfusion defect here, you are right
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| me007
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a perfusion defect occurs when blood flow to the alveoli is obstructed.
this interfers withthe normal exchange of O2 btw alveoli and pulm capillariesand result in decreased arterial pO2.
In this pt the perfusion defect is caused by pulm infarction
Pulm infarctions are common in hospitalized pts bcs of blood stasis -->deep venous thrombosis.
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| keepgoing
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will patient improve if given O2???
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| virgola82
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I don't know whether my reasoning is right, but I would consider "ventilation defect" a deficient inspiratory pump, so for instance a pt with costal fractures, excessive myorelaxants, COPD etc I mean all conditions in which he can't exchange adequate volume of air and therefore he's gonna develop increased pCO2 and low pO2;
on the other hand I would consider atelectasis, ARDS, pneumonia, pulmonary edema, PE etc more as Vent/Perf ratio abnormalities. In this case the patient would have low pO2 but normal to low pCO2. This because of compensating increased resp rate driven by the low pO2 that wouldn't affect blood O2 content (hemoglobin is already almost 100% saturated in blood exiting lung) but would reduce blood CO2 content (linear relation instead of sigmoid)
In this case there is clearly a Vent/Perf ratio abnormality but because the only option matching with the patophys is perfusion deficit I chose that.
By the way it shouldn't improve giving oxigen
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