Solved

A 36-Year-Old Woman Comes to the Emergency Department Because of Worsening

question 23

Multiple Choice

A 36-year-old woman comes to the emergency department because of worsening shortness of breath and cough for 4 days. Her medical problems include rheumatoid arthritis, interstitial lung disease on home oxygen, and pulmonary hypertension. Her trachea is cannulated because of respiratory distress and central venous access is obtained.
In the intensive care unit, her temperature is 37.2 C (99 F) , blood pressure is 99/67 mm Hg, and pulse is 120 /min. The patient's pulse oximetry shows 100% on assist control mode with tidal volumes of 300 mL, respiratory rate of 20/min, fraction of inspired oxygen (FiO₂) of 100%, and positive end-expiratory pressure (PEEP) of 5 cm H₂O. Examination reveals right-sided crackles and decreased breath sounds on the left. Heart sounds are regular with a loud second heart sound. The abdomen is soft and non-tender. Examination shows no peripheral edema.
Laboratory values are as follows:
$A 36-year-old woman comes to the emergency department because of worsening shortness of breath and cough for 4 days. Her medical problems include rheumatoid arthritis, interstitial lung disease on home oxygen, and pulmonary hypertension. Her trachea is cannulated because of respiratory distress and central venous access is obtained. In the intensive care unit, her temperature is 37.2 C (99 F) , blood pressure is 99/67 mm Hg, and pulse is 120 /min. The patient's pulse oximetry shows 100% on assist control mode with tidal volumes of 300 mL, respiratory rate of 20/min, fraction of inspired oxygen (FiO2) of 100%, and positive end-expiratory pressure (PEEP) of 5 cm H2O. Examination reveals right-sided crackles and decreased breath sounds on the left. Heart sounds are regular with a loud second heart sound. The abdomen is soft and non-tender. Examination shows no peripheral edema. Laboratory values are as follows: A chest radiograph is performed. Which of the following is the most appropriate next step in management? A) Increase PEEP B) Increase tidal volume C) Insert a chest tube D) Reposition the endotracheal tube E) Suction respiratory secretions$
A chest radiograph is performed.
$A 36-year-old woman comes to the emergency department because of worsening shortness of breath and cough for 4 days. Her medical problems include rheumatoid arthritis, interstitial lung disease on home oxygen, and pulmonary hypertension. Her trachea is cannulated because of respiratory distress and central venous access is obtained. In the intensive care unit, her temperature is 37.2 C (99 F) , blood pressure is 99/67 mm Hg, and pulse is 120 /min. The patient's pulse oximetry shows 100% on assist control mode with tidal volumes of 300 mL, respiratory rate of 20/min, fraction of inspired oxygen (FiO2) of 100%, and positive end-expiratory pressure (PEEP) of 5 cm H2O. Examination reveals right-sided crackles and decreased breath sounds on the left. Heart sounds are regular with a loud second heart sound. The abdomen is soft and non-tender. Examination shows no peripheral edema. Laboratory values are as follows: A chest radiograph is performed. Which of the following is the most appropriate next step in management? A) Increase PEEP B) Increase tidal volume C) Insert a chest tube D) Reposition the endotracheal tube E) Suction respiratory secretions$
Which of the following is the most appropriate next step in management?

Definitions:

Succession Planning

The process of identifying and developing new leaders who can replace old leaders when they leave, retire, or die.

Retirement

The phase in life where one voluntarily leaves their job or career, often due to age.

Instrumental Support

Assistance provided to someone in the form of tangible aid or service, such as financial help or offering resources.