Acute Respiratory Failure...? or distress??
HI,
I have a case different than I have ever had. Acute respiratory Failure is written, copd exacerbation... Hmmmmm... but the physical description of the patient is the most I've ever had described. I feel funny asking for clinical validation when symptoms are severe. I have asked 3 nurses, 1 doc and a coder/audit specialist... everyone has similar response... sounds like distress...BUT, it sure looks like respiratory failure, but No o2??
I won't go into the gases but they don't really help. possible erroneous info ( per conversation with clinician).
admit vs-37.7, 120, 26, 92%,,,ra...
3/30-venous gas- 7.39. cp2- 36, p02 74 hco3 23 base deficit -3
Provider excerpts-
- ED- .... wheezes... accessory muscle use... speaks 2-4 word sentences... Acute respiratory distress, COPD exac...... pulse ox 98%...tachypneic...subjectively reporting feeling SOB despite medical interventions... ed flow sheet...increasing resp distress since yesterday....warm diaphoretic...leaning forward in tripod, audible wheezes...and visible retractions and speaking in short sentences------ sats 92-98 % on RA...pt still using accessory muscles, still unable to speak in full sentences...
3/30 admit orders- Acute respiratory failure/COPD
3/30- H&P- .... chronic respiratory failure due to copd...dyspnea was worse with some fever and hot sweats at home. He has nonproductive cough. In the emergency room, he was severely dyspneic with a respiratory rate
in the high 20s to 30s and his saturation was around 90%. He received 1 hour continuous nebulizer's and 1 dose of Solu-Medrol, but he is still wheezing and appears in moderate respiratory distress.... acute on chronic hypoxemic respiratory failure... COPD exacerbation... probably due to acute viral infection...
Any opinion on audit vulnerability?? and if so...advice ??
I have a case different than I have ever had. Acute respiratory Failure is written, copd exacerbation... Hmmmmm... but the physical description of the patient is the most I've ever had described. I feel funny asking for clinical validation when symptoms are severe. I have asked 3 nurses, 1 doc and a coder/audit specialist... everyone has similar response... sounds like distress...BUT, it sure looks like respiratory failure, but No o2??
I won't go into the gases but they don't really help. possible erroneous info ( per conversation with clinician).
admit vs-37.7, 120, 26, 92%,,,ra...
3/30-venous gas- 7.39. cp2- 36, p02 74 hco3 23 base deficit -3
Provider excerpts-
- ED- .... wheezes... accessory muscle use... speaks 2-4 word sentences... Acute respiratory distress, COPD exac...... pulse ox 98%...tachypneic...subjectively reporting feeling SOB despite medical interventions... ed flow sheet...increasing resp distress since yesterday....warm diaphoretic...leaning forward in tripod, audible wheezes...and visible retractions and speaking in short sentences------ sats 92-98 % on RA...pt still using accessory muscles, still unable to speak in full sentences...
3/30 admit orders- Acute respiratory failure/COPD
3/30- H&P- .... chronic respiratory failure due to copd...dyspnea was worse with some fever and hot sweats at home. He has nonproductive cough. In the emergency room, he was severely dyspneic with a respiratory rate
in the high 20s to 30s and his saturation was around 90%. He received 1 hour continuous nebulizer's and 1 dose of Solu-Medrol, but he is still wheezing and appears in moderate respiratory distress.... acute on chronic hypoxemic respiratory failure... COPD exacerbation... probably due to acute viral infection...
Any opinion on audit vulnerability?? and if so...advice ??
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