Kettering Clinical simulation (Rojo Rodriguez) 100% correct answers already graded A+

You are a staff therapist assigned to the emergency department of a 420 bed medical center. Shortly after arriving for the 7:00AM-7:00PM shift, you are called to the ED to assist in the care of a 37 year old man rescued from a burning barn on his horse ranch. He is 5'9 (175 cm) tall and weighs 170 lb (77 kg). When you observe the patient in trauma room 4, your rapid assessment reveals that Mr. Rodriguez is tachypneic, tachycardic and appears to be profound respiratory distress with audible wheezes. Your initial action is to: A-1. perform arterial puncture A-2. administer albuterol by small volume nebulizer A-3. administer oxygen by nasal cannula at 5L/min A-4. administer oxygen by non-rebreather mask at 15 L/min A-5. request a stat portable A-P chest radiograph A-4. administer oxygen by non-rebreather mask at 15L/min (Done, go to section D) The emergency room physician asks you to perform an assessment on Mr. Rodriguez. Which of the following would you include in your assessment at this time? Select as many as you consider indicated in this section: D-1. chest x-ray D-2. arterial blood gas D-3. complete blood count D-4. hemoximetry D-5- serum electrolytes D-6. urinalysis D-7. sputum culture D-8. diagnostic chest percussion D-9. tracheal reflexes D-10. electrocardiogram D-11. sweat chloride levels D-12. gag reflex D-13. troponin level D-14. echocardiogram D-15. bronchial lavage D-16. babinski reflex D-17. exhaled gas analysis D-18. temperature D-19. pulse oximetry D-20. blood pressure D-21. sensorium D-22. respiratory pattern D-23. chest movement D-24. posture D-25. heart rate D-26. skin color D-27. general appearance D-21. sensorium (conscios, alert and oriented) D-22. respiratory pattern (45 breaths/min, intercostal retraction, use of accessory muscles, marked high pitched inspiratory sound) D-23. chest movement (bilateral movement noted) D-24. posture (high fowler position) D-25. heart rate (140/min) D-26. skin color (normal lips and eyelids appear cherry-red in color) D-27. general appearance (appears anxious, first degree burns about face and neck, singed nasal, redness around lips) (Go to section C) What recommendation would you now make to the physician? Choose only one unless you are directed to "Make another selection in this section C-1. continue current therapy C-2. initiate hyperbaric oxygen therapy C-3. perform endotracheal intubation C-4. administer albuterol by small volume nebulizer STAT C-5. adinister racemic epinephrine by small volume nebulizer STAT C-3. perform endotracheal intubation (done, patient on 100% O2 via T-piece. Go to section E) Thirty minutes later, the physician asks you to reevaluate the patient's condition. Which of the following would you include in your assessment at this time? Select as many as you consider indicated in this section E-1. tracheal reflexes E-2. complete blood count E-3. urinalysis E-4. diagnostic chest percussion E-5. maximum voluntary ventilation E-6. arterial blood gas E-7. chest auscultation E-8. vital signs E-9. capillary refill E-10. tracheal position E-11. gag reflex E-12. CT scan of abdomen with contrast E-13. hemoximetry E-14. past medical history E-15. lung diffusing capacity (DLCo) E-16. blood culture E-17. social history E-18. polysomnogram E-19. sensorium E-20. breathing pattern E-2. complete blood count (RBC 4.9 mill/cu mm, Hb 14.9 g, Hct 45%, WBC 5,800/cu mm) E-4. diagnostic chest percussion (resonant bilaterally) E-6. arterial blood gas (pH 7.51, PaCO2 30 torr, PaO2 400 torr, HCO3 28 mEq/L) E-7. chest auscultation (bilateral vesicular sounds with a few inspiratory crackles) E-8. vital signs (temperature 37.5C (99.5F), pulse 110/min, respirations 27/min, BP 130/88 mmHg) E-9. capillary refill (color returns within seconds) E-10. tracheal position (midline) E-13. hemoximetry (O2 Hb 70%, COHb 30%) E-14. past medical history (fractured femur 4 years ago, appendectomy at age 12 yr, no known allergies) E-17. social history (non-smoker, no history of drug abuse, drinks red wine socially) E-19. sensorium (conscious, alert, oriented) E-20. breathing pattern (bilateral chest expansion, no retractions) Go to section B Based on your findings, which of the following would you now recommend to the physician? Choose one only unless you are directed to make another selection in this section B-1. reduce FIO2 B-2. maintain current therapy B-3. initiate mechanical ventilation B-4. administer racemic epinephrine by small volume nebulizer B-5. administer intravenous corticosteroids B-2. maintain current therapy End of simulation