A.W., a 52-year-old woman disabled from severe emphysema, was walking at a mall when she suddenly grabbed her right side and gasped, “Oh, something just popped.” A.W. whispered to her walking companion, “I can’t get any air.” Her companion yelled for someone to call 911 and helped her to the nearest bench. By the time the rescue unit arrived, A.W. was stuporous and in severe respiratory distress. She was intubated, an IV of lactated Ringer’s (LR) to KVO (keep vein open) was started, and she was transported to the nearest emergency department (ED).

On arrival A.W. is stuporous, tachycardic, and cyanotic. The paramedics inform the physician that it was difficult to ventilate A.W. arterial blood gases (ABGs) are obtained. A.W. Her ABGs on 100% oxygen are pH 7.25, Paco₂ 92 mm Hg, Pao₂ 32 mm Hg, HCO₃ 27 mmol/L, base excess (BE) +5 mmol/L, Sao₂ 53%.

1. On arrival to the ER what assessments would be a priority for the nurse or doctor to perform? Be specific in your answers.

2. What exams and lab tests would you suggest to be done and why.

3. What do you think the diagnosis would be for this patient?

4. Describe the findings of the arterial blood gas results.