darkhorse
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Posts: 275
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A 72-year-old smoker is admitted to the hospital for COPD exacerbation. Admission vitals are respirations 18/min, with a blood pressure of 180/100 mm Hg, and an oxygen saturation of 91%. He is started on nebulized albuterol and ipratropium bromide, as well as prednisolone intravenously. Admission chest radiograph reveals flattened hemidiaphragms, increased retrosternal clear space, and hyperlucent lungs. Given a suspicion of pulmonary embolus, a ventilation perfusion scan is performed demonstrating nonsegmental perfusion defects of the left upper lobe, with a small left lung and a complete absence of perfusion and ventilation of the entire right lung. The patient becomes acutely short of breath in the nuclear medicine department. His respirations are 30/min with otherwise normal vital signs. After supplemental oxygen (4 L/min by nasal cannula) and nebulizers are administered, the respirations become 29/min, with a blood pressure of 80/40 mmHg, and an oxygen saturation of 82%. A repeat chest radiograph is pending. The most appropriate management is to
A. administer heparin, intravenously
B. insert a chest tube on the left side
C. insert a chest tube on the right side
D. obtain a surgical consult for emergent lung volume reduction surgery
E. send him for coronary artery catheterization
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| dr.wad
Forum Senior
Topics: 3
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C 
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| aaroho
Forum Junior
Topics: 8
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yep it's c for tension pneumothorax
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| darkhorse
Forum Elite
Topics: 56
Posts: 275
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When going gets tough, the tough gets going
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