A few weeks ago I wrote a column about a patient with H. Flu epiglottitis. The patient’s level of carbon dioxide went up so high that he stopped breathing.
We often think of carbon dioxide as a breathing problem. That makes sense. If we do not breathe correctly, we may not exhale enough carbon dioxide. That is what happened with the patient with epiglottitis.
However, the body sometimes works in strange ways. Back in the early 1980s we admitted a patient with H. Flu meningitis. The vaccine was not developed until a few years later.
My intern asked me to start a new IV on the patient. He did not think the one he started was stable enough.
I went to the patient to start the IV. I was looking for a location. However, I noticed that the patient’s color did not appear to be quite right. I asked the nurse to get the crash cart.
When it arrived, we started him on oxygen. I then drew a blood gas to see if the poor color was due to a low oxygen level.
I no sooner sent the gas to the lab when the patient stopped breathing. We resuscitated him successfully. By the time the resuscitation ended, we had the blood gas result back.
The oxygen level would normally be between 95 and 100. We were already giving him oxygen when the blood gas was drawn. The result came back at about 250. His poor skin color was clearly not due to lack of oxygen.
However, his carbon dioxide level came back over 60. It was so high that he had stopped breathing. He had no pulmonary issues. His problem was meningitis.
Apparently the brain infection had affected his central breathing mechanism. He had stopped blowing off a sufficient amount of carbon dioxide because of that. The result was that the level had gone high enough to have him stop breathing.
It turned out to be a good thing that he needed another IV. If he had not, no one would have been in the room to notice the color change.
He recovered from his meningitis and his respiratory arrest successfully. Sometimes it helps to be in the right place at the right time.
Carbon dioxide is controlled by more than just the lungs. You have to look at the whole patient. Sometimes you get surprised.
COVID update- Despite all the gloom and doom in the national media, the new case numbers continue to follow last July’s pattern (see chart). Sussex County went from 90 new cases last week to 136 this week.
There are still many people that do not understand the simple math of the pandemic. We know that the infection will continue until we reach herd immunity. Herd immunity means that so many people have antibodies that the virus has no one left to infect. Antibodies come from vaccine. Antibodies come from natural infection.
We all learned that 1 + 1 = 2. The equation for COVID-19 is similar. Vaccine antibodies + infected antibodies = herd immunity. The bottom line is that people will either get vaccinated or infected. There is no way around that. Vaccination would get us there faster.
Some people have the perception that the choice is to get vaccinated or not get vaccinated. That is an incorrect perception. The choice is to get vaccinated now or get infected later. It is that simple.
The American Heart Association published the results of a study on July 15. It showed that high risk medical conditions alone are only a part of the equation.
Patients with high cholesterol on statin medications had a lower death rate from COVID-19. Patients with high blood pressure controlled by medication had a lower death rate from COVID-19. Patients on both drugs had a lower death rate from COVID-19 infections.
The bottom line is that you are at higher risk of dying if you have a medical condition and do not take medication to control it.