A Hypoxic Patient

S – Situation

• Chief Complaint: Hypoxia.

• Diagnosis: Aspiration Pneumonia 

• Full code

• 63-year-old female, non-verbal at baseline, presented from SNF with O₂ sat in 60s.

• On ED arrival: O₂ sat 90s RA, tachycardic to 120s, afebrile.

B – Background

• PMH: Depression, HTN, CAD, HFrEF (EF 28% in 2016), CVA with baseline non-verbal status.

• PSH: C-section, wrist surgery.

• Social History: No smoking, alcohol, or drug use.

• Family History: Mother—cancer, diabetes, stroke.

• Allergies: None.

• Medications: Held PO on admission (med rec in progress).

A – Assessment

• ED Course:

  • VS: Temp 97.4, HR 117→80, BP 104/81, SpO₂ 94% RA.

  • Labs: Na 142, K 3.6, CO₂ 22, Cr 0.49, BNP 1690, Trop T 58→49→52, WBC 10, Hgb 9.8, MCV 114, Plt 366, INR 1.11.

  • VBG: pH 7.34, lactate 2.5.

  • UA negative, Viral PCR negative.

  • Imaging:

    • CTA chest: no PE, LLL patchy consolidation → infection vs aspiration.

    • CXR: negative.

    • CT head: negative for acute process, chronic encephalomalacia noted.

  • Treatments given: IV Zofran, Zosyn x3, Vancomycin x2, 500 mL NS bolus.

• Exam: On nasal cannula, anicteric, RRR, bilateral chest congestion, non-verbal neuro baseline.

• Current Vitals: T 97.1 °F, HR 80, BP 104/81, RR 18, SpO₂ 94% on 2 L NC.

• Weight: ~42.5 kg (stable decline since 2016).

• Assessment: Acute hypoxic respiratory failure likely secondary to aspiration pneumonia.

R – Recommendation / Plan

• Admit for acute hypoxic RF from aspiration pneumonia.

• Respiratory: O₂ as needed, monitor saturation.

• Infection: Start Unasyn IV.

• Nutrition: NPO, pending  swallow eval.

• Fluids: D5 NS @ 75 mL/hr.

• Meds: Hold all PO medications. Switch Depakote → IV Valproate 250 mg BID.

• Monitoring/Labs: CBC, CMP, Mg, Phos.

• Prophylaxis: DVT prophylaxis with Lovenox.

• Activity: Fall precautions with bedrest until further evaluation. 

• Diet: NPO.

• Code status: Full code per W-10.