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Hypoxia in a Patient With Bullous Emphysema


Case Study

The bedside nurse activated a rapid response code for a patient who appeared to be in acute respiratory distress and had new right-sided chest pain. On arrival of the rapid response team (RRT), the patient was found to be a 62-year-old male with a history of chronic obstructive pulmonary disease (COPD) who was admitted one day ago for COPD exacerbation. Overnight, the patient was placed on bilevel positive airway pressure (BiPAP) therapy for respiratory acidosis. In the 10 min before the RRT event, the patient became acutely dyspneic with increasing lethargy and right-sided chest pain.

Vital Signs

  • Temperature: 37.4 °F, axillary

  • Blood Pressure: 90/50 mmHg

  • Heart Rate: 122 beats per min (bpm)

  • Respiratory Rate: 30 breaths per min

  • Oxygen Saturation: 70% on room air, 90% on 15 L/min (LPM) non-rebreather

Focused Physical Examination

A quick exam revealed a middle-aged male lying in bed in obvious distress. The patient appeared drowsy and tachypneic, using accessory muscles of respiration. There was reduced air entry on the right lung field, and the left lung was clear to auscultation. His cardiac examination revealed tachycardia with normal heart sounds. His abdomen was non-tender and non-distended. The remaining examination was unremarkable.

Working diagnosis

Acute respiratory failure because of COPD exacerbation vs. acute respiratory distress syndrome vs. pneumothorax

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