A 47-year-old - ritonavir

[ArchivalUser]

But the cor pulmonal is due to long standing COPD, so start the routine work up by chest x-ray which will help also to exclude any lung mass (smoking history). After that, PSG should be done to determine if there is OSA needing CPAP.
I agree that ABG should be done, but not sure if that is the best next step in that particular patient. Any other opinions?

[ArchivalUser]

Such patients with COPD or OSA with exacerbation will have alarming retention of CO2 sometimes even more than 100 pCO2 even with normal pO2 or SaO2 .... such patients need urgent NIV ... so i thought of urgent ABG ... also patient has only dry cough and also no crepts on chest auscultation ... so i kept the possibility of infection or cardiac condition leading to pulm edema quite low in my DD.

[ArchivalUser]

My entries don't seem to work. I'll try again. I see Harish's point here. Next step after excluding reversible causes would be to exclude decompensation and hypercapnoea (increasing sleepiness during day as in this chap) as this would need immediate Tx (NIPPV), then do workup for CPAP/LTOT, etc..

[ArchivalUser]

My point is that I can't see from the stem the the patient is an acute case needing emergency intervention; symptoms since 5 weeks, coming to the office not the ED and able to give history, so he doesn't seem to have an acute respiratory failure with a very high pco2.

[ArchivalUser]

I agree. I'm sticking with CXR. He doesn't have imminent signs of severe hypercapnea....tachycardia, etc....and his RR is normal, ie. he's not in respiratory distress.

[ArchivalUser]

to jorg ... your point is well taken ... even his RR is normal ... does not seem to be an acute case ... you may be right.

[ArchivalUser]

answer?

[ArchivalUser]

the correct answer is DDDDD

[ArchivalUser]

explantaion plz..

[ArchivalUser]

I was thinking AA,,,Whats the source of Qs ritonavir???