A 45-year-old woman arrives in the emergency department after ingesting an unknown quantity of pain medication and alcohol.She was found unconscious in her apartment by her friend.She is currently unresponsive to verbal stimuli.Vital signs reveal: pulse 56/min,respiratory rate 10 and shallow,BP 90/50.Her arterial blood gas on room air reveals: pH 7.21,partial pressure of carbon dioxide (PaCO₂) 64 mm Hg,partial pressure of oxygen (PaO₂) 52 mm Hg,bicarbonate (HCO₃-) 24 mEq/L.The appropriate treatment for this patient includes which of the following?
1) Naloxone hydrochloride (Narcan)
2) Nasal cannula 4 L/min
3) Nonrebreathing mask
4) Intubation and ventilatory support

Question

Quizplus · Accepted Answer

The arterial blood gas (ABG)values indicate that this patient has acute respiratory failure because the patient is not moving air,as evidenced by the partial pressure of carbon dioxide in the arteries (PaCO₂)of 64 mm Hg.This patient also has hypoxemic respiratory failure due to the hypercapnic respiratory failure.Since this is the case,plus the fact that the patient is unconscious due to a drug overdose,the patient's airway must be protected.Therefore,intubation and ventilatory support are necessary to protect the airway and maintain the patient's ventilations until she wakes up.To assist in reversing the central nervous system (CNS)and ventilatory depression,naloxone hydrochloride should be given.This drug is an opioid antagonist.The oxygen devices suggested in the answers are not appropriate because they will not address the patient's hypercapnic respiratory failure.

A 45-Year-Old Woman Arrives in the Emergency Department After Ingesting