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A 72yoM presents to ED with CHF exacerbation. Awake
and alert but in distress. Using accessory respiratory
muscles and says it's hard to breathe.
Vitals: HR 120, BP 120/80, RR 34, SpO2 90% on 8L
simple face maks.
PE: bilateral lower extremity edema, crackles in posterior
lung fields.
CXR: bilateral fluffy infiltrates consistent with pulmonary
edema
ABG: pH 7.3, PCO2 50, PO2 64
In addition to diuresis, which of the following is the best
next step in this patient's management?
A) intubate and initiate invasive mechanical ventilation
B) initiate noninvasive positive pressure ventilation
C) switch to nonrebreather oxygen mask
D) switch to high-flow, high-humidity oxygen - Answer-B)
initiate noninvasive positive pressure ventilation
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A 27yoM admitted to ICU with SAH after MVC. Initial GCS
8 with labored respirations. He was intubated in the ED
and placed on a ventilator. Shortly after arrival to the unit,
SpO2 reads 57% with HR 46 and no pulse.
Which of the following is the safest and most immediate
method to verify correct ET tube placement?
A) palpation over the epigastrum for abdominal distention
B) manual bag-mask breathing
C) qualitative exhaled carbon dioxide monitor or detector
D) portable chest radiograph - Answer-C) qualitative
exhaled carbon dioxide monitor or detector
A 52yoM presents after a MVC with hypotension and
obvious signs of hemorrhagic shock. FAST exam is
positive, and an emergent surgical consult is obtained for
operative intervention. While awaiting surgeon and
transport to OR for definitive hemorrhage control, his BP
continues to decline and resuscitation begins.
Which of the following is the best strategy for resuscitation
in this setting of massive hemorrhage?
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A) infusion of packed red blood cells only until laboratory
results are available to assess for the presence of
coagulopathy and thrombocytopenia
B) balanced resuscitation using a combination of packed
red blood cells, fresh frozen plasma, and platelets in a
1:1:1 ratio
C) limited infusion of IV fluids or blood products until
definitive control of hemorrhage is achieved, regardless of
blood pressure or hemodynamic status
D) aggressive isotonic crystalloid infusion to maintain
normal blood pressure - Answer-B) balanced resuscitation
using a combination of packed red blood cells, fresh
frozen plasma, and platelets in a 1:1:1 ratio
A 76yoF PMHx CHF, HTN is admitted with AMS and mild
upper respiratory sxs. According to family, her mental
status gradually declined over the last 3 days. Because
generalized weakness and upper respiratory sxs, limited
amount of food/drink in the last 72hrs. Home meds:
metoprolol, lisinopril, furosemide. Family states she's
compliant.
Vitals: HR 118, BP 96/53, RR 14, SpO2 98% RA
Dry mucous membranes, poor skin turgor, absence of
JVD. Clear on auscultation. Opens eyes to voice,
mumbles incomprehensible sounds, generalized