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What should we do next??(NBME)
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Author5 Posts
  #1

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


  #2

I put N

___________________
As a general rule, the better it felt when you said it, the more trouble it's going to get you into.

  #3

AGREE

  #4

why?

  #5

c

___________________
But they that wait upon the LORD shall renew their strength; they shall mount up with wings as eagles; they shall run, and not be weary; and they shall walk, and not faint-Isaiah 40:31







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