This 32-year-old woman was diagnosed as AML in Apr 1999,
with an initial presentation of easy bruising. She underwent
allogeneic bone marrow transplantation in Feb 2000.The
post-BMT course was complicated by GVHD, pulmonary TB,
interstitial pneumonitis and steroid myopathy. HRCT showed
bronchiectasis with peribronchial thickening. She was in a
depressed mood in Aug 2002 due to corneal ulcer. On Sep 23,
2002, she was found lying unconscious in her room and burned
coal was found nearby. She was sent to a local hospital where
respiratory acidosis was found. Some unknown drugs were also
found in the trashcan. Because of suspected CO intoxication,
she was referred to the ER of a teaching hospital where fever,
hypotension, and tachycardia were noted. The blood gas
analysis showed respiratory acidosis and the HbCO was 25.8%.
She was intubated and transferred to the ICU for further
care.
體檢發現(Evident Physical
findings): Consciousness: drowsy but
oriented BP 130/71mmHg (Dopamine 20ug/Kg/min); T/P/R
37.6/135/18 HEENT: conjunctiva not pale; anicteric
sclerae Neck: supple; no LAP or JVE Chest: symmetric
expansion; clear breath sound Heart: RHB; no murmur
Abdomen: soft and flat; normoactive bowel sounds; no
organomegaly Extremity: freely movable; no cyanosis or
edema Skin color : no specific change
住院治療經過(Course and
Management): The CxR
(Figure
1 ) revealed
only mild interstitial infiltrates over both lower lung
fields, which did not differ from her previous films. The
follow-up HbCO level on Sep. 23 was 0%. She was extubated on
Sep. 24. However, there was still CO2 retention and dyspnea was noted.
Intermittent BiPAP support was instituted. She was transferred
to general ward on Sep. 26. The bronchodilator test showed
severe obstructive defect without response to inhaled β
2-agonist. She was discharged on Oct 2 in a stable
condition.
呼吸治療經過
日期 時間 |
9/23 10:50 |
16:00
|
9/24 08:50 |
14:00
|
9/26 09:00 |
Mode |
ACMV |
ACMV |
PSV |
Mask |
Mask |
PEEP |
10 |
10 |
5 |
|
|
FiO2 |
1.0 |
1.0 |
0.58 |
0.98 |
0.4 |
pH |
7.36 |
7.446 |
|
7.282 |
7.296 |
PaCO2 |
35.2 |
27.1 |
|
54.1 |
55.9 |
PaO2 |
402.1 |
145.6 |
|
349.1 |
72.1 |
HCO2 |
19.4 |
18.2 |
|
25 |
26.6 |
BE |
-4.8 |
-4.1 |
|
-2.6 |
-0.9 |
SpO2 |
100 |
100 |
96 |
98 |
98 |
備註 |
COHb=25.8 |
|
RR=31 VT=265 RSI=117 COHb=0 |
13:30拔管 BiPAP standby |
9/26
3pm 轉病房 |
|