Case study: the practitioners Voice is your section of continuing education animated by professionals of the health. This very first case was proposed by Dr Ezéchiel BANKOLE, hospital practitioner (FRANCE). You too, do likewise by sharing with other colleagues cases from all over the world, specifying your title and country of provenance.
Mr H. D, 54yrs, 82kg, 1.76m is admitted to Intensive Care on 11/09/2017 for acute respiratory distress in a context of non-febrile fatty cough with yellowish sputum of average abundance evolving for 7 days.
It is an active (30 AP), autonomic, active chronic ethyl (several alcohol withdrawal failure), poorly controlled hypertensive and non – insulin dependent diabetic patients.
Its current treatment includes: Metformin, Amlodipine, Vitamin Therapy B1 and B6, Paracetamol.
The interview did not find antibiotics or corticosteroids in the previous days. One finds as dominant complaint a left latero-thoracic pain with a feeling of blocking of the breathing at times.
Objective clinical examination essentially consists of signs of wrestling and crackling rales at the level of the base of the right lung and some sibilant rales on the left. SpO2 is 87% under 10L / min of oxygen at high concentration mask, the temperature is at 35 degrees C; the FC is at 120 / min regular, the TA is at 9/6, the breath is fetid and the diuresis appears preserved.
1 °) You are asking for a chest x-ray of the face that shows the following image: What is your diagnosis hypothesis when reading this photograph? What comments does the reading of this cliché raise?
2) Arterial gasometry shows a pH at 7.15, a PCO2 at 58mmHg, a PO2 at 65mmHg, bicarbonate at 15mmHg. The patient becomes drowsy. What are you doing ?