Chapter

The puncture wound must have admitted air into the pleural cavity (pneumothorax), raising the intrapleural pressure and causing collapse of the right lung. Since the left lung is located in a separate pleural compartment, it was unaffected by the wound. As a result of the collapse of his right lung, Harry was hy-poventilating. This caused retention of CO2, thus raising his arterial PCO and resulting in respiratory acidosis (as indicated by an arterial pH lower than 7.35). Upon recovery, analysis of his arterial blood revealed that he was breathing adequately but that he had a carboxyhemoglobin saturation of 18%. This very high level is probably due to a combination of smoking and driving in heavily congested areas, with much automobile exhaust. The high carboxyhemoglobin would reduce oxygen transport, thus aggravating any problems he might have with his cardiovascular or pulmonary system.

The significantly low FEV1 indicates that Harry has an obstructive pulmonary problem, possibly caused by smoking and the inhalation of polluted air. A low FEV1 could simply indicate bronchoconstriction, but the fact that Harry's vital capacity was a little low suggests that he may have early-stage lung damage, possibly emphysema. He should be strongly advised to quit smoking, and further pulmonary tests should be administered at regular intervals.

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