A 59-year-old patient is in severe respiratory distress in the emergency department.The patient is being treated for congestive heart failure and pulmonary edema.Vital signs are pulse 98/min,respiratory rate 23/min,and BP 138/98.The patient's arterial blood gas results on a nonrebreather mask are as follows: pH 7.35,partial pressure of carbon dioxide (PaCO₂)45 mm Hg,partial pressure of oxygen (PaO₂)49 mm Hg,arterial oxygen saturation (SaO₂)79%,and bicarbonate (HCO₃-)24 mEq/L.The respiratory therapy that is most appropriate at this time is which of the following?

Question

Quizplus · Accepted Answer

This patient's oxygenation is not responding well to the nonrebreather mask.This is indicative of refractory hypoxemia.The next step in the treatment of a patient with congestive heart failure (CHF)who is moving air would be to use a continuous positive airway pressure (CPAP)mask with supplemental oxygen.CPAP is very effective in the treatment of hypoxemia caused by heart failure.It can relieve some of the vascular congestion,reduce the patient's work of breathing,and improve gas exchange.This patient is not quite a candidate for intubation and mechanical ventilation because he is still moving air as evidenced by his partial pressure of carbon dioxide in the arteries (PaCO₂)of 45 mm Hg.Both the nasal cannula and air entrainment mask,in this case,are a step backwards in the management of this patient.

A 59-Year-Old Patient Is in Severe Respiratory Distress in the Emergency