which scenarios are examples of physical changes

Low tidal volume ventilation (LTVV), also known as lung protective ventilation, has been demonstrated to significantly The diagnosis of ALI requires all three of the following: (a) bilateral pulmonary infiltrates, (b) a PaO 2:FiO 2 ratio of ≤ 300 and (c) echocardiographic evidence of normal left atrial pressure or pulmonary-artery wedge pressure of ≤ 18 mm Hg (2). FiguresĪfter admission to the ICU, the patient was noted to be in acute lung injury (ALI), a subset of acute respiratory distress syndrome (ARDS). Human immunodeficiency virus (HIV) serology was negative.Īrterial blood gas (ABG) analysis performed on room air on presentation to the ICU: pH 7.49, PaCO 2 29 mm Hg, PaO 2 49 mm Hg. Purified protein derivative (PPD) administered via Mantoux testing was 8 mm in size at 72 hr after placement. Sputum cultures showed moderate growth of Pasteurella multocida.ĢD transthoracic ECHO of the heart showed normal valves and an ejection fraction of 65% with a normal left ventricular end-diastolic pressure and normal left atrial size. BAL gram stain was without organisms or polymorphonuclear leukocytes. Three sputum samples were negative for acid-fast bacilli (AFB).īronchoalveolar lavage (BAL) white blood cell count 28 cells/µl, red blood cell count 51 cells/µl, negative for AFB and negative Legionella culture. Liver function tests revealed albumin 2.1 with total protein 4.6, normal total bilirubin, aspartate transaminase (AST) 49, Alanine transaminase (ALT) 19 and alkaline phosphatase 47. Urine sodium <10 mmol/L, urine osmolality 630 mosm/kg Serum sodium was 125 mmol/L, potassium 3 mmol/L, chloride 91 mmol/L, bicarbonate 21 mmol/L, blood urea nitrogen 14 mg /dl, serum creatinine 0.6 mg/dl and anion gap of 14. White blood cell count was 11,000/mm 3 with 38% neutrophils, 8% lymphocytes, 18 % monocytes and 35% bands His neurologic status had also significantly deteriorated with worsening confusion, memory loss, drowsiness, visual hallucinations (patient started seeing worms) and worsening upper extremity tremors without generalized tremulousness despite receiving increased doses of benzodiazepines. By hospital day 5, his respiratory status continued to worsen, requiring transfer to the intensive care unit (ICU) for hypoxemic respiratory failure. Diazepam was initiated and titrated using the Clinical Institute Withdrawal Assessment for Alcohol Scale (CIWAS-Ar), a measure of withdrawal severity (1). He was initiated on ceftriaxone, azithromycin, thiamine and folic acid. Hospital course He was initially admitted to the general medical floor for treatment of community-acquired pneumonia (see Figure 1) and for the prevention of delirium tremens. Other than daily multivitamin tablets, he took no regular medications. The patient’s past medical history was remarkable for chronic “shakes” of the upper extremities for which he had not sought medical attention. He collected coins and cleaned them with mercury. He had worked in the steel mills but had discontinued a few years previously.

He reported ingesting twelve beers daily and had had delirium tremens, remote right-sided rib fractures and a wrist fracture as a result of alcohol consumption. The patient smoked one pack of cigarettes daily for the past 50 years and denied recreational drug use. He recalled childhood exposures to persons afflicted with tuberculosis. He also denied sick contacts or a recent travel history. He had denied fevers, chills, myalgias or vomiting. He had unintentionally lost approximately 30 pounds over the last 6 months and had nightly sweats.

The associated cough was productive of yellow sputum without hemoptysis. The chest pain was pleuritic in nature and had been present for the last month.

A 60-year-old man presented to the emergency department complaining of persistent right-sided chest pain and cough.

Which scenarios are examples of physical changes