docnikki
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1 A 62-year-old woman is brought to the emergency department 1 hour after a 1-minute episode of loss of consciousness; her symptoms began when she stood up after she passed a dark, watery stool. She has had diarrhea and dark stools for 2 days. She has been receiving warfarin therapy for deep venous thrombosis for 2 weeks. On arrival, her blood pressure is 82/60 mm Hg, and pulse is 150/min and regular. She is unable to stand. The lungs are clear to auscultation. A grade 2/6 systolic murmur is heard at the second right intercostal space with no radiation. Examination shows a soft, nontender abdomen. There is 1+ edema of the right lower extremity with no tenderness. Test of the stool for occult blood is positive
[font="">[font=" size='2"' Helvetica, Arial, sans-serif?>C) Conversion reaction
[font=" size='2"' Helvetica, Arial, sans-serif?>E) Hypoglycemia
[font=" size='2"' Helvetica, Arial, sans-serif?>G) Orthostatic hypotension
[font=" size='2"' Helvetica, Arial, sans-serif?>I) Seizure
[font=" size='2"' Helvetica, Arial, sans-serif?>K) Vertebrobasilar insufficiency
Q2)A 67-year-old woman has been intubated for 1 week after undergoing a left lobectomy for lung cancer. She has chronic obstructive pulmonary disease. Her preoperative functional vital capacity was 40% of predicted. She is awake and alert. Her blood pressure is 130/75 mm Hg, and pulse is 72/min. The ventilator settings are a synchronized intermittent mandatory ventilation of 8/min, FIO2 of 40%, and positive-end expiratory pressure of 5 cm H2O. Arterial blood gas analysis shows:
pH 7.42
PCO2 47 mm Hg
PO2 90 mm Hg
O2 saturation 96%
Which of the following is the most appropriate next step in management?
A) Antibiotic therapy
B) Bronchodilator therapy
C) Chest physiotherapy
D) Decrease inotropes
E) Diuretic therapy
F) Fiberoptic bronchoscopy
G) Heparin therapy
H) Incentive spirometry
I) Increase FIO2[/font]
J) Increase inotropes
K) Increase respiratory rate
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L) Placement of thoracostomy tube
M) Tracheostomy
N) Wean from the ventilator[/size">
[/font]
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| Aashi
Forum Moderator
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G) Orthostatic hypotension
N) Wean from the ventilator
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| nadiabarati
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G
K increase respiratory rate
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| yasmeen
Forum Guru
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Posts: 940
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G
N
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| eaguin
Forum Senior
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Pleased, Can someone explain me why choose wean from the ventilator over increase repiratory rate?
Thank you...
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| robin082006
Forum Hero
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Orthostatic hypotension
I picked increased RR when I did NBME, but now revise and answer may be wean mechanical ventilation. not sure.
Can anyone post criteria for weaning mechanical ventilation?
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| docnikki
Forum Guru
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Criteria to be used to consider a patient for<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />
weaning.
1) Underlying disease process that necessitated ventilation has resolved or
improved.
2) Pa O 2 / Fi O 2 > 200 (PEEP <5, Fi O 2 < 0.5, P H e” 7.25).
3) Afebrile, conscious and coherent.
4) Stable Cardiovascular Function:
a) HR <140/min
b) Absence of myocardial ischaemia
c) Absence of vasopressors or low dose inotropes.
5) Hb>8 g%.
6) absence of respiratory acidosis
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| docnikki
Forum Guru
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I think its weaning because I read that weaning is started as soon as patient is on mechanical ventilator.
any more points if anyone knows regarding this topic plz post aas kaplan doesnt cover this topic. thanks everyone.
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| fongch
Forum Elite
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Posts: 316
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But what about the elevated PCO2 in patient #2?
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