I was called for this patient 2 weeks ago .
Mr Z is a 76 year old male with history of COPD, DM , chronic renal insufficiency, Coronary artery disease and osteoarthritis presented to our ER with shortness of breath ,mild hypoxia and chest pain .
IT seemed like the cause of his chest pain was cardiac so we admitted him to our maxicare unit . His first set of cardiac enzymes was mildly positive with a troponin of 0.2 , EKG showed some changes that were old .
On exam his sats were 90% on 2 liters of O2 by nasal cannula, temp - low grade temp , RR = 18
Bp = 130/75
his exam was as follows
HEENT EOMI , PERRLA , pink conj , no pallor , no icterus
Neck supple , no JVD no LAN , no bruit
Chest decreased air entry on bases , no wheezes , no rales
Heart S1 S2 heard , systolic ejection murmur no rub no gallop
Abd soft , not tender , not distended but obese , bowel sounds were heard
Ext - no edema , no cyanosis , no clubbing but there was a question of splinter hges on his nail beds , peripheral pulses felt bilaterally
Neuro exam cranial nerves intact , motor power 5/5 , sensory system intact , DTR 2+ bilaterally - essentially grossly non focal
Rectal - occult blood -ve , normal sphincter tone and no masses
so Mr Z was worked up as a rule out myocardial infarction case and endocarditis
I was called at 11 pm because the nurse found Mr Z unresponsive .
I walked into the room , Mr Z who is usually a fussy patient is unresponsive to verbal , tactlie and painful stimuli
His vitals are as follows:
Bp 130/70 RR 18 P 65 Pox 97% on 5 liters
The nurse said the following - she walked into Mr Z's room 1.5 hours ago , his sats were dropping to 80% on 2 liters so she placed the patient on a 100% ventimask for an hour , his sats started going up and have been up since then .
What do you think happened to this patient?