J.H. is a 52-year-old white man who comes to the emergency department complaining of shortness of breath. He has not seen a health care provider for many years.
•Has a 38 pack-year history of cigarette smoking
•States he has always been slender but has had 25-lb weight loss despite a normal appetite in the past few months
•Admits to a “smoker’s cough” for the past 2 to 3 years; recently coughing up blood
•Is married and the father of three adult children
•Thin, pale man looking older than stated age
•Height 6 ft; weight 135 lb (61.2 kg)
•Intermittently confused and anxious with rapid shallow respirations
•Vital signs: temperature 102.6° F (39.2° C), heart rate 120, respiratory rate 36
•Chest wall has limited excursion on right side; auscultation of left side reveals coarse crackles but clear with cough; right side has diminished breath sounds
•Arterial blood gases: pH 7.21, PaO2 58 mm Hg, PaCO2 82 mm Hg, HCO3− 33 mEq/L, O2 saturation 84%
•Chest x-ray: consolidation of the right lung, especially in the base with possible mass in the area of right bronchus; pleural effusion on the right side
•Bronchoscopy with biopsy of mass: small cell lung carcinoma
1. How would you classify J.H.’s pneumonia? Why is this important?
2. What is your analysis of J.H.’s arterial blood gas results?
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