A 63-Year-Old Man with Chronic Obstructive Pulmonary Disease Is Brought

question 64

Multiple Choice

A 63-year-old man with chronic obstructive pulmonary disease is brought to the emergency department due to fever, chills, and shortness of breath for 5 days.  His medications include aspirin, inhaled albuterol, and inhaled ipratropium.  The patient has smoked a pack of cigarettes daily for 43 years and drinks 3-4 cans of beer daily.  His trachea is intubated in the emergency department due to respiratory distress, and intravenous antibiotics and glucocorticoids are initiated.
In the intensive care unit, temperature is 38.3 C (100.9 F) , blood pressure is 130/80 mm Hg, pulse is 132/min, and respirations are 22/min.  Pulse oximetry shows 94% on assist-control mode with a tidal volume of 550 mL, respiratory rate of 22/min, fraction of inspired oxygen of 60%, and positive end-expiratory pressure of 5 mm H₂O.  Examination reveals diffuse crackles over the left lung, normal S1 and S2, and clubbing.
Laboratory studies are as follows:
Chest-x ray shows a left-sided infiltrate and hyperinflated lungs.  The ventilator waveforms show air trapping.
Which of the following is the most appropriate next step in management of this patient?

• A)Decrease expiratory time
• B)Decrease inspiratory flow
• C)Decrease respiratory rate
• D)Increase fraction of inspired oxygen
• E)Increase tidal volume

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Definitions:

Formal Reasoning

A cognitive process involving the use of logical operations or established principles to arrive at conclusions, often associated with higher-order thinking and problem-solving.

Everyday Reasoning

Mundane reasoning that differs from formal reasoning in its use of implicit premises, multiple solutions, personal relevance, and possible emotional involvement.

Premises

Statements or propositions that serve as the basis for a conclusion or argument.

Wason's Four-card Task

A logical puzzle presented as a psychological experiment to study conditional reasoning and bias in decision making.