Interstitial Lung Disease
Patient Presentation
RJP, a 68 year old female presented to the ER with dry cough for the last month and short of breath. She woke up and was not able to catch her breath and her husband called 911. RJP was transported via ambulance to the emergency room. Her husbands stated RJP has a history of HTN, DM, and breast cancer. EMT found RJP tachypneic with labored breathing, she was confused. They immediately placed a non-rebreather on her. When she arrived to the ER she was lethargic.
Diagnosis/Treatment
A blood gas and chest x-ray were ordered. The blood gas showed: PH 7.36, PaO2 59, PaCO2 30, HCO3- 23. The chest x-ray showed her lungs where opaque. Even with RJP being on the non-rebreather she was still laboring to breath. The medical team decided to intubate her; they didn’t know what was causing this. She was intubated and transferred to the ICU. They started her on steroids. Pulmonary decided to perform a bronchoscopy to obtain tissue samples. Her results came back positive for pulmonary fibrosis. After 1 week she was able to be weaned from the vent. She was extubated and the next day sent to a step-down unit.
They doctors were able to diagnose her with interstitial lung disease, the cause was unknown. Her lungs were severely scarred. The damage was done and was not reversible. She arrived to the floor. She was receiving schedule nebulizer treatments. ICU was able to wean her down to 12L Hi-flow nasal cannula (HFNC). Any type of physical activity would cause her O2 sat to drop to 60%; she was alert and oriented and would start breathing harder to increase her O2 sat. We had to increase her O2 to 15L until her O2 sats would increase. It would take a couple of minutes but she would be able to increase her O2 sat. The medical team tried to talk to the patient about becoming DNR and going on palliative care. She was not ready to hear this and just dismissed them. She wanted everything done.
Outcome
RJP was discharged to a nursing home on 12L HFNC after being in the hospital for 2 weeks. She is still a full code.
Case created by Rachel Petrus, 2012.