Respiratory arrest

[stephynic21]

i just have a quick question about why my patient had respiratory arrest. It said in her chart that she presented in the ER at one hospital with complications of COPD/pneumonia. She had SOB, weakness, and pain when breathing in. They have her Lasix IV and immediately following that she went into resp arrest and had to be intubated. Lasix is something that she takes at home, so was she most likely already having complications that would eventually lead to that, or was that something that the Lasix did being it was given iv? Her chart was very vague and i just didn't understand. The staff was busy and i didn't want to be a burden.

Also, all this happened on 4/3. Is the respiratory arrest the reason why she is still in the hosptial? After she was intubated, she was also put on a PEG tube and foley. They PEG and foley have been DC'd (yesterday).

[Daytonite, BSN, RN]

How would Lasix cause respiratory arrest? Did you look at her ABGs? Did you read her physician's progress notes? What other medical problems and drugs was she getting? Was there heart failure going on as well? Pneumonia and COPD can cause the alveoli of the lungs to become severly obstructed which would be one reason why respiratory failure and arrest happened.

[Be_Moore]

The lasix did not cause the respiratory arrest, they just happened to be next to each other chronologically. Likely she had pulmonary congestion (CHF) on top of the above problems. Even if she didn't, lasix is a pretty standard treatment for breathing problems because it is a quick fix for a probable problem. The respiratory failure was likely more related to her underlying COPD.

What likely happened:

1) Pneumonia tends to start in the bases of the lungs and work upwards, think gravity. Unfortunately, the bases of the lungs are also where most of the actual respiration (VQ matching, perfusion) occurs..with some occuring in the mid lung and almost none happening in the apex. So, her ability to oxygenate was compromised.

2) This was exacerbated by her COPD. Either she has chronic bronchitis (and can't get enough air into the lungs anways) or she has emphysema (and can't get air out of the lungs).

3) These two things add together to create a big problem with lung perfusion and blood oxygenation. As her blood O2 drops, CO2 starts to rise creating an acidotic state. Hyperventilation occurs to blow off the CO2 (compensatory) but this only makes the problem worse for her..the faster breathing does no good because she's not getting enough air into the lungs to make a difference and isn't holding the air long enough to recruit the collapsing alveoli. Blood CO2 continues to rise, pH continues to fall. Eventually the body can no longer compensate and the lack of O2 and increasing acidosis starts to produce changes in mental status. At a certain point, respiratory arrest occurs. When the arrest will occur is different person to person, but on a long enough timeline with these problems, compensation is less likely than arrest. Had she only had pneumonia and no underlying COPD and CHF, she likely could have compensated with tachypnea alone..but the comorbid lung issues made compensating impossible.

As for the arrest being the reason she's still in the hospital, maybe..maybe not. Is she still intubated? Then yes. If not, then it's because of the pneumonia and they are waiting on resolution of the pneumonia before they transfer/discharge...because if they discharge her with pneumonia and pulmonary congestion that is unresolved..she'll be back.

Hope this helps!

[stephynic21]

Thanks =) i still hadn't resolved why she had respiratory failure, but when i got to clinical today my instructor told me basically the same thing that you just did. I just couldn't wrap my head around it last night haha. she was intubated but it was removed on monday, they observed her yesterday for complications....and she was discharged right when i got to clinical so i spent the day in the wound care.

[ghillbert, MSN, NP]

Sounds like she was fluid overloaded, infected (pneumonia) and possibly in pulmonary edema. What do you mean, she "went into respiratory arrest"? Stopped breathing? Had low O2 sats? Poor blood gases? Terminology is important. If she STOPPED breathing, I could only imagine she was hypercapnic. Otherwise, compromised ventilation would have led to hypoxia and/or hypoxemia requiring intubation.

[Natingale, EdD, RN]

did you take her vitals when you assessed her? sometimes nurses push meds without checking the condition of the patient, so they couldve been in distress before the medication