HEALTH CARE Essay Example | Topics and Well Written Essays - 750 words

HEALTH CARE - Essay Example The initial X-ray appears to be normal (pre-op). The pulmonary findings of subsequent radiograph in this patient, 3 days post-op resembles that of acute respiratory distress syndrome (increased interstitial pattern). No cardiac or pulmonary effusions were noted. This might have superimposed the findings of pneumonia and atelectasis secondary to mechanical ventilation. The third radiograph taken 4 days post operative shows decreased interstitial pattern suggestive of recovery. Post- surgery, the PO2 levels were very low, suggestive of hypoxemia. This can be expected in fat embolism (Weinhouse 2000). The PCO2 levels are also low suggestive of hyperventilation. The bicarbonate levels are slightly low, which is an attempt to compensate for the alkalosis. The overall picture of ABG is that of respiratory alkalosis. Following this, mechanical ventilation has improved the oxygenation which is evident in the subsequent ABGs. The pCO2 and bicarbonate levels have normalized and the pH is in the normal range. However the PaO2 levels have been fluctuating through out the first day post-op. The differential diagnosis mentioned is pulmonary thromboembolism, lipid embolus, myocardial infarction and pulmonary edema. The investigations reveal normal hemoglobin and platelet count, prolonged PT, normal LAP, normal urine analysis, normal liver function and renal function tests and normal cardiac profile enzymes. ABG is suggestive of severe hypoxemia and respiratory alkalosis, chest X-ray is suggestive of increased interstitial pattern and EKG showed no fresh ischemic changes. The EKG and normal cardiac enzymes rule out repeat myocardial infarction. The absence of Watermark’s sign in the chest X-ray rules out pulmonary embolism. However, the best method of ruling out this condition would be to do Doppler ECHO, rapid D- dimer tests and V/Q lung scan. PT/PTT would be normal in this condition. ABG would show fairly normal