Auto Injury : A Case Study in Acid-Base Balance
Mr. Wilson , a 60-year-old male, was on his way home from workafter snowing all day. Mr. Wilson slide on the icy street through ared light where he was hit by an oncoming truck. The other driversuffered only minor bruises and cuts, Mr. Wilson demonstratedlabored breathing and severe chest pain. Mr. Wilson was in thetrauma centers ER in less than 2 mins. Mr. Wilson had experiencedblunt trauma from the impact of the steering wheel after the airbagfailed to deploy.
Mr. Wilson examination revealed, blurred vision, dizziness,headache, nausea, muscle weakness, hypoventilation, and a feelingof mental confusion. A Ct scan revealed bilateral fractures in thefourth, fifth, and six ribs and a possible hemothorax. An ECGrevealed signs of ventricular arrhythmias. The values followingvalues were taken from the results of an arterial blood gas (ABG)and urinalysis (UA).
Aterial Blood Gas(ABG)Â Â Â Â High orLow
pH:Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â 7.1Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Low
Pco2:Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â 58Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â High
bicarbonate:   33 mEq/L           High         Â
Urinalysis (UA)
pH:Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â 3.7Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Low
Short Answer Questions
1. Mr. Wilsons’s PCO2 is elevated. Under normalconditions, what would be the PRIMARY mechanism that his body woulduse to reduce the amount of PCO2 in the blood? Why isthis mechanism not working in this case?
2. Describe how the high PCO2 and low pH in Mr.Wilson’s blood are related in this case.
3. Describe how the high bicarbonate in Mr. Wilson’s blood isrelated to the low pH in his urine.
4. What type of intervention might the doctors and nursesinitiate in order to address the hemothorax? Explain how thisintervention will lead to changes in PCO2 and bloodpH.
