Organ failure case study question 1The male patient first presents with complaints of a dry cough, blood in sputum, fever, sweating and weight loss. A two week history of a dry cough and fever suggests that it is an acute cough, which usually manifests with respiratory infection. Sweating, haemoptysis and unexplained weight loss are all common clinical sign of lung cancer, pneumonia and tuberculosis.On the examination, his respiratory rate is 28/min ie. hyperventilation, suggesting that he is suffering from a condition that cause insufficient oxygen delivered to the blood. On ABG results, his PaO2 is very low. The saturation of haemoglobin with oxygen (SO2) is also lower than the normal range.
This could be caused by obstruction in the airway or ventilation-perfusion mismatch, where shunting has occur. Since he is not hypoventilating, which usually causes hypoxemia, the problem might lie within the lung where the lung is well profused but not well ventilated. There is also a rise in blood pressure where the heart pumping force has increased to compensate for the low oxygen saturation in blood being delivered to rest of the body.
From the information provided by ABG, the patient is suffering from type 1 respiratory failure. It is clearly seen that he has dyspnoea because he is using his accessory muscle to breath, suggesting forced respiration probably cause by disturbance of ventilation, gas exchange or ventilation-perfusion mismatch. Clubbing of finger can manifest in patients with hypoxia condition where there is insufficient oxygen delivered to the tissue.
Gathering information from social history, he does not have a fixed home to live, suggest that the environment he is living now has some influence to his condition. The patient has a history of smoking, chronic alcoholism and drug abuse, all these contained substances are injurious to pulmonary tissue; these factors contribute to the respiratory failure.With all this information taken into account, our differential diagnosis is: (1) Pulmonary infection, for example pneumonia, upon first admission to the hospital; (2)Chronic Obstructive Pulmonary Disease (COPD) which is the obstruction of the airway; (3) Acute Respiratory Distress Syndrome (ARDS) resulting from injury to the alveolocapillary membrane that leads to severe pulmonary oedema- in this case more prominent in left lung; (4) Lung cancerAll these condition manifest the common clinical symptoms such asdyspnoea, hyperventilating, cough, blood in sputum, and finger clubbing.