HYPOXEMIA
HYPOXEMIA: Excerpt from Algorithmic Diagnosis of Symptoms and Signs
Ask the Following Questions:
- What is the carbon dioxide level? An increased carbon dioxide level suggests pulmonary emphysema, asthma, pickwickian syndrome, respiratory paralysis, central nervous system disease, kyphoscoliosis, drug effects, and disorders of the chest wall and spine.
- What does spirometry show? If spirometry shows a decreased 1-second timed vital capacity with an increased carbon dioxide level, consider emphysema and asthma likely. If the timed vital capacity is normal, a diagnosis of pickwickian syndrome, respiratory paralysis, central nervous system disease, drug effects, and chest wall and spine disorders should be considered.
- If the carbon dioxide level is normal or decreased, what does the chest radiograph show? A focal infiltrate suggests pulmonary infarct, congestive heart failure, or pneumonia. A diffuse infiltrate or negative chest x-ray suggests congestive heart failure, pulmonary fibrosis, shock, pulmonary or intracardiac shunt, sarcoidosis, pneumoconiosis, or alveolar proteinosis.
- What does a perfusion scan show? If this is positive, consider pulmonary infarction.
- What does the pulmonary capillary wedge pressure show? If this is increased, consider congestive heart failure. If this is decreased, the patient may have hypovolemic shock. If it is normal, consider a right-to-left shunt, pulmonary fibrosis, pneumoconiosis, or sarcoidosis.
DIAGNOSTIC WORKUP
Repeated arterial blood gases should be done. A CBC, urinalysis, chemistry panel, methemoglobin, sulfhemoglobin, carboxyhemoglobin, venous pressure and circulation time, blood volume, serial ECGs, CT scan of the chest, lung biopsy, additional pulmonary function tests, and consultation with a pulmonologist or cardiologist will be necessary in many cases.
Book Source Details
- Book Title: Algorithmic Diagnosis of Symptoms and Signs
- Author(s): R. Douglas Collins
- Year of Publication: 2003
- Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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