Question

An adult patient in the emergency department is febrile with a temperature of 40 deg C (104 deg F) taken rectally. Arterial blood gas analysis is done and the following results are reported with the patient breathing room air. The results are not corrected for temperature.

pH 7.35 PaCO2 46 torr
PaO2 80 torr
HCO3- 26 mEq/L
BE +1 mEq/L
The respiratory therapist should recommend
A. Ventilatory assistance with Bi-level
B. Supplemental oxygen by nasal cannula at 5 L/min
C. A cooling blanket
D. Non-invasive positive pressure ventilatory support (NIPPV)

Answer 1

The patient has a slight form of compensated respiratory acidosis; therefore, the recommended intervention is the use of a cooling blanket to address the high fever that could further impair respiratory function.

Step-by-step explanation:

The adult patient in the emergency department with a high fever and the given arterial blood gas (ABG) values is exhibiting signs of compromised respiratory function.

The ABG results show a pH of 7.35, PaCO2 of 46 torr, PaO2 of 80 torr, HCO3- of 26 mEq/L, and base excess (BE) of +1 mEq/L.

These values indicate that, despite the PaCO2 being slightly elevated, the pH is at the low end of the normal range due to buffering by bicarbonate. This suggests a form of respiratory acidosis with compensation.

Since the oxygen level (PaO2) is adequate, providing supplemental oxygen is not immediately necessary.

A cooling blanket would be the most appropriate initial step to address the fever (40 deg C), which can exacerbate or trigger respiratory issues by increasing metabolic demand and potentially further impairing respiratory function.