Abstract
C. S. is a 51-year-old, morbidly obese black male, with a history of tobacco smoking, crack cocaine abuse, chronic obstructive pulmonary disease (COPD) and an elevated left diaphragm following a left cervical blunt trauma. He was admitted for gradual exacerbation of his baseline shortness of breath. He reported increased cough and greenish sputum production. He had clinical symptoms and signs suggestive of obstructive sleep apnea. His physical examination was remarkable for morbid obesity, weighing 324 lbs (147.3 kg), increased respiratory rate of 30 breaths per minute, supraclavicular fullness, use of accessory respiratory muscles, and decreased breath sounds bilaterally at lung bases. His arterial blood gases (ABG) show pH 7.21, PaCO2 88 mmHg, PaCO2 45 mmHg, and HCO3 32 mEq/L. His oxygen saturation while breathing room air was 76 %.