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V.M. is a 39-year-old black man who has sickle cell disease (SCD) marked by frequent episodes of severe pain. His anemia has been managed with multiple transfusions, and he shows signs of chronic renal failure. He is a nonsmoker, nondrinker, and is on Social Security disability. His regular medications are pentoxifylline (Trental), oxycodone/acetaminophen (Roxicet), and folic acid (Folvite). In hematology clinic this AM, V.M.’s Hgb measured 6.7 g/dl. He received 2 units PRC (packed rerd cells) over 3 hours and then went home. V.M. developed dyspnea and shortness of breath approximately 1 to 1 ½ hours later, and his wife called 911. The EMS (emergency medical system) crew initiated oxygen and transported V.M. to the ED.
- V.M.’s ABG’s on 9 L O2/ simple face mask are pH 7.34, PaO2 74mmHg, Pa CO2 33mmHg, HCO3 18 mEq/L, BE -6. Is V.M being adequately oxygenated, why or why not?
- Why would V.M. be concerned about obtaining adequate pain control? And especially in the E.D?
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