tamerbashir
Forum Elite
Topics: 20
Posts: 284
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20. 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
J
) Increase inotropes
K
) Increase respiratory rate
L
) Placement of thoracostomy tube
M
) Tracheostomy
N
) Wean from the ventilator
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| tamerbashir
Forum Elite
Topics: 20
Posts: 284
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plz for explainaion
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| usmle12
Forum Senior
Topics: 19
Posts: 194
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increase resp rate...i have no clue
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| tamerbashir
Forum Elite
Topics: 20
Posts: 284
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| sherry39
Forum Junior
Topics: 3
Posts: 105
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bBBB..as patient have stable vitals...ABGs show respiratory alkalosis....ie increased rate..o2 saturation is good..pCO2 is increased...showing some obstruction
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| farnsworth
Forum Newbie
Topics: 0
Posts: 165
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N: weaning (SIMV is the worst ventilatory modality for weaning). Switch to CPAP w/ an inspiratory pressure support to overcome the superimposed resistance caused by the endotracheal tube. The blood gases are excellent for someone w/ a COPD post-lobectomy, I would just extubate the patient. Remember: you can always use non-invasive ventilation (NIV) after extubation or simply re-intubate.
If one suspects obstruction -> modern ICU ventilators have displays, so one could have a look at the flow tracing. If an inspiration is initiated before the expiratory flow ceased, obstruction can be suspected. The ideal ventilator shows pressure, flow, and volume tracings simultaneously on one display!
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