Case 31: Severe Decrease in Lung Compliance During a Code Blue
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An 80-year-old, weight 90 kg and height 5′7’, male with a past medical history of coronary artery disease, diabetes mellitus, right inguinal hernia, hypertension, chronic obstructive pulmonary disease, and end-stage renal disease requiring hemodialysis is admitted to an intermediate ICU with upper gastrointestinal bleeding. He is conscious, pale, cold, and clammy. Since he complains of being cold, he is covered with several blankets. His BP is 90/40 and his heart rate is 120 sinus rhythm. His Hct is 20, and he is transfused with three units of packed red blood cells over a 40-min period. Following this he becomes unresponsive with very weak respiratory efforts. A one-stick radial arterial blood gas shows a pH 6.9, pCO2 107, and paO2 of 53 on a 100% O2 non-rebreather mask.
KeywordsGeneral anesthesia Lung compliance Code blue Upper gastrointestinal bleed Hypotension pneumoperitoneum Distended abdomen Subxiphoid catheterization Angiocath Respiratory failure Mask ventilation Draping of patients