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NBME FORM 2 q,plz ans
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Author8 Posts
  #1

E) Reintubation and mechanical ventilation

  #2

B

UW has a similar q, answer is bronchoscopy to remove mucus, so that I picked A with hope that this method will help release obstruction due to mucus.

But I review again, this patient has hypoxia so B is the first step.

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  #3

i think E

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  #4

this pt has Resp acidosis with resp 10/min next step will be Reintubation and mechanical ventilation.

  #5

E
Criteria for intubation:
-Uncorrectable hypoxemia (pO2 < 55 on 100% O2 NRB).
- Hypercapnia (pCO2 > 55) with acidosis (pH<7.25)
-Ineffective respiration (max inspiratory force < 25 cm H2O)
-Fatigue (tachypnea with increasing pCO2).
- Airway protection.
- Upper airway obstruction.
- Septic shock.




  #6

ya ,it is E bcos giving oxygen alone doesnot correct his respiratory acidosis



Common medical indications for mechanicalventilation include (from wikipedia)




  • acute lung injury (including ARDS, trauma)

  • apnea with respiratory arrest, including cases from intoxication

  • chronic obstructive pulmonary disease (COPD)

  • acute respiratory acidosis with partial pressure of carbon dioxide (pCO2) > 50 mmHg and pH < 7.25, which may be due to paralysis of the diaphragm due to Guillain-Barré syndrome, Myasthenia Gravis, spinal cord injury, or the effect of anaesthetic and muscle relaxant drugs

  • tachypnea with respiratory rate > 30

  • hypoxemia with arterial partial pressure of oxygen (PaO2) with supplemental fraction of inspired oxygen (FiO2) < 55 mm Hg

  • hypotension including sepsis, shock, congestive heart failure






  #7

yes its E .

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  #8

E









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