Back to BASICS! Clinical Reasoning about Mr. G's Oxygenation
Mr. G. has several things going on.
First: He is a poster boy for aspiration pneumonia! He has very likely suffered changes in level of consciousness (from various causes) to the degree that the reflexes protecting his airway were depressed. Though he is mounting an immune response (fever and elevated WBC's) his native ability to fight infection might be less than robust due to chronic illness and poor nutrition.
Second: On x-ray, he has findings consistent with pneumonia. The nurse's assessment of his breath sounds suggests consolidated, poorly aerated lung tissue in his bases (where aspirated material likes to settle!) and there are coarse adventitious sounds suggesting mucous/exudate in his airways.
Third: (and most importantly) he has refractory hypoxemia. Take a second and read about this phenomenon.
First: He is a poster boy for aspiration pneumonia! He has very likely suffered changes in level of consciousness (from various causes) to the degree that the reflexes protecting his airway were depressed. Though he is mounting an immune response (fever and elevated WBC's) his native ability to fight infection might be less than robust due to chronic illness and poor nutrition.
Second: On x-ray, he has findings consistent with pneumonia. The nurse's assessment of his breath sounds suggests consolidated, poorly aerated lung tissue in his bases (where aspirated material likes to settle!) and there are coarse adventitious sounds suggesting mucous/exudate in his airways.
Third: (and most importantly) he has refractory hypoxemia. Take a second and read about this phenomenon.