58yo, 3 broken ribs after a fall. Splinting, taking tiny shallow breaths.
Got IV hydromorphone an hour ago. Now drowsy, RR 10, SpO2 89%.
ABG: pH 7.28, PaCO2 58, HCO3 25.
◀ All casesCase 8 of 8
Case 8 · Respiratory acidosis (ABG)
Shallow Breaths
Bedside monitorLive
pH7.28
PaCO258
HCO325
SpO289%
NAME THIS ABG
Answer: A) Respiratory acidosis, uncompensated
Respiratory acidosis, uncompensated. She isn't breathing off enough CO2.
ROME: Respiratory = Opposite (pH down, CO2 up). Metabolic = Equal. pH under 7.35 = acidosis. PaCO2 over 45 = the lungs caused it. HCO3 normal (22-26) = no compensation yet.
NURSE MOVE: Rouse her, coach deep breaths, raise the HOB, O2 per orders, call the provider. Opioids + RR this low? Naloxone per protocol.
RememberCO2 up, pH down? It's the lungs.