Acute Respiratory Failure Case Study

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Recommended: Pathophysiology of diabetic neuropathy

Reason for review Major Complication Acute Renal Injury and acute respiratory failure

84 year old female admitted on 5/10/16 by Q029 for a right THR under General anesthesia after a failed attempt of spinal anesthesia. Preop medical and cardiac clearance obtained. Preop SCr 1.69 patient was and ASA class 3
PMH: hypertension, dyslipidemia Osteoarthritis, Stage III chronic kidney disease
Past Surgical History: L Hammer Toe, R TKR,

Patient underwent surgery on 5/10/16 after receiving Ancef 2 grams prior to incision. Surgery proceeded as planned upon removing the broach it was noted that there was a fracture in the proximal aspect of the lesser trochanter which extended distally and laterally. At which time 2 cerclage wires were placed around …show more content…

H/H 9.9/31.2 B/P 135/55 HR 103 R 24 O2 sat 94 Hospitalist M324 responded to the code, patient intubated by ED physician E093. ABG DONE-PH 6.87 CO2 125 O2 44 HCO3 22, the patient received 1 amp of Bi carb for the acidosis.
R/o PE Heparin drip started. Venous Doppler studied report negative and chest x-ray obtained report no change from previous study no CTA 2nd to renal function
The patient was transferred to ICU consults called with intensivist M288. PICC line inserted at 15:30. Antibiotics started for suspected sepsis cultures taken.
Nephrology consult called with M169 for Acute Kidney injury on Chronic Renal Failure. M169 consult impression Acute Kidney injury superimposed on Chronic Kidney Disease most likely 2nd to ATN caused by Hypoxia and Hypotension, severe metabolic acidosis 2nd to acute kidney injury.
Pulmonology consult called with M160 for respiratory failure. M160 impression agonal respirations were due to medical condition with acute renal failure and postop state, obesity and narcotic analgesics and R/O PE

5/14/2016 PO day 4 Scr 2.62 H/H 6.5/18.7 transfused 2 units PRBC. Ventilator weaning held due to blood …show more content…

Passed swallowing evaluation done after extubation O2 sat post weaning 98-95 on 2L N/C Xaralto 15mg x1 given to bridge from IV heparin

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