A 60-Year-Old Man Comes to the Emergency Department Due to Several

question 171

Multiple Choice

A 60-year-old man comes to the emergency department due to several hours of right lower quadrant pain and vomiting.  His oral intake has been minimal for the last 12 hours.  Past medical history is notable for well-controlled hypertension.  An abdominal CT scan demonstrates appendicitis, and the patient is taken to the operating room.  He vomits during rapid sequence induction for intubation, requiring repeat suctioning from the mouth and trachea.  The surgery is otherwise uneventful; the patient receives a total of 2 liters of intravenous crystalloids in the intra- and peri-operative period and maintains normal hemodynamics and urine output.  Approximately 4 hours later, he is tachypneic and hypoxemic.  Temperature is 37.2 C (99 F) , blood pressure is 150/80 mm Hg, and pulse is 95/min and regular.  Pulmonary examination reveals bilateral crackles.  ECG is unremarkable.  Arterial blood gas analysis demonstrates PO₂ of 67 mm Hg on a fraction of inspired oxygen of 90%.  Chest x-ray reveals bilateral infiltrates.  Which of the following is the most likely mechanism of lung injury?

• A)Cardiogenic fluid overload
• B)Infection of airways from oropharyngeal contents
• C)Inflammatory reaction to aspirated gastric acid
• D)Negative pressure pulmonary edema
• E)Ventilator-associated bacterial pneumonia

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Definitions:

Revoked

The act of officially withdrawing, canceling, or reversing a decision, privilege, or status.

Donor

A person who makes a gift.

Mutual Benefit Bailment

A bailment arrangement where both the bailor and the bailee receive a benefit from the transaction involving personal property.

Reasonable Care

The degree of caution and consideration an individual or organization is expected to exercise in a particular situation to avoid harm to others or their property.