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A 35-year-old man develops acute respiratory distress
syndrome from smoke inhalation injury. He is receiving
invasive mechanical ventilation in volume assist control mode.
His ventilator settings are: tidal volume 350 mL (6 mL/kg ideal
body weight), respiratory rate 28 breaths/min, gas flow rate 80
L/min, and positive end-expiratory pressure (PEEP) 10 cm H2O.
His plateau pressure on these settings is 26 cm H2O. Arterial
blood gas analysis reveals: pH 7.28, PCO2 50 mm Hg, PO2 50
mm Hg, bicarbonate 26 mmol/L, and oxygenation saturation
82%. Which of the following is the most appropriate next step in
management?
A. Increase PEEP to 14 cm H2O.
B. Increase the respiratory rate to 35 breaths/min.
C. Start a bicarbonate infusion.
D. Lower the tidal volume to 5 mL/kg ideal body weight. -
ANSWER -A increase
PEEP to 14
A 68-year-old man with Crohn disease was admitted with a
small bowel fistula. Now on postoperative day 2 after a small
bowel resection, he has hematochezia, nausea, vomiting,
, abdominal pain, and distention. Heart rate is 134 beats/min and
blood pressure is 84/52 mm Hg. Hemoglobin is 6.2 g/dL.
Pulse oximetry has a poor waveform and readings are poor and
inconsistent. Which of the following is the most likely causing
the poor pulse oximetry readings
A. Drop in hemoglobin
B. Excessive nail polish
C. Elevated carbon dioxide
D. Vasoconstriction - ANSWER -D vasoconstriction
A 46-year-old man with a history of polysubstance abuse, body
mass index of 20, and prominent thyroid cartilage is found
obtunded. He is intubated and admitted to the ICU. He
subsequently regains consciousness, becomes agitated, and
violently pulls out his endotracheal tube. He is unable to
breathe; attempts to assist him with bag mask ventilation are
unsuccessful. Direct laryngoscopy reveals swollen, edematous
vocal cords with no glottic opening seen. His oxygen saturation
is now 76%. Which of the following methods is most
appropriate to re-establish an airway?
A. Establish airway patency by using Rapid Sequence
Intubation
B. Attempt placement of a supraglottic airway (laryngeal mask
airway) and call for immediate surgical backup
C. Placement of a nasopharyngeal airway
D. Videolaryngoscopy with size 7.5 endotracheal tube -
ANSWER -B B. Attempt placement of a supraglottic airway
(laryngeal mask airway) and call for immediate surgical
backup