By M. Derek. George Fox University.
His hemoglobin O2 saturations are 92% on 2 L of oxygen provided by nasal cannula purchase extra super avana 260 mg on line. Results of blood gas measurements are as follows: pH purchase extra super avana 260mg online, 7. ECG shows lateral T wave inversions; otherwise, ECG results are unremarkable. For this patient, which of the following statements regarding hypercapnic respiratory failure is true? This patient should be admitted to the hospital because he has acute hypercapnic respiratory failure and will likely require mechanical ventilatory support B. As with acute hypoxemia, the effects of hypercapnia on the central nervous system are typically irreversible C. Acute hypercapnic respiratory failure is defined as a PaCO2 greater than 45 to 50 mm Hg along with respiratory acidosis D. Acute elevation in PaCO2 to 80 or 90 mm Hg is generally well tolerat- ed, but levels in excess of 100 mm Hg often produce neurologic signs and symptoms Key Concept/Objective: To understand the clinical effects and the management of acute and chronic hypercapnia Acute hypercapnic respiratory failure is defined as a PaCO2 greater than 45 to 50 mm Hg along with respiratory acidosis. Signs and symptoms of hypercapnia depend not only on the absolute level of PaCO2 but also on the rate at which the level increases. A PaCO2 above 100 mm Hg may be well tolerated if the hypercapnia develops slowly and acidemia is minimized by renal compensatory changes, as is the case with this patient. Acute elevation in PaCO2 to 80 to 90 mm Hg may produce many neurologic signs and symptoms, including confusion, headaches, seizures, and coma. A careful neurologic examination of a patient with acute hypercapnia may reveal agitation, coarse tremor, slurred speech, asterixis, and, occasionally, papilledema. These effects of hypercapnia on the central nervous system are fully reversible, unlike the potentially permanent neurologic sequelae that are associated with acute hypoxemia. A 52-year-old man with severe emphysema presents to the emergency department with shortness of breath and altered mental status. She states that the patient was in his usual state of health until 24 hours ago, when he awoke with fever and shortness of breath.
Patients who have had macu- lopapular or morbilliform skin rashes are not at higher risk for immediate skin reaction purchase extra super avana 260mg line, but skin testing may be considered because studies have demonstrated that patient histo- ries can be unreliable buy generic extra super avana 260 mg. Cephalosporins and penicillin share a similar bicyclic β-lactam structure; patients with a history of penicillin allergy are more likely than the general pop- ulation to have a reaction. Carbapenems (imipenem) and carbacephems can have signifi- cant cross-reactivity with penicillin. Vancomycin would not be indicated in this patient if a skin test can be obtained; if the skin test is positive, desensitization to penicillin can be performed. A 33-year-old man is admitted to the hospital with fever, knee pain, and swelling. Physical examination is remarkable for fever and a swollen, red, painful right knee. Arthrocentesis shows gram-positive cocci in clusters and 150,000 white blood cells. After a few minutes, you are called to see the patient, who is complaining of flushing and back pain. His blood pressure is 90/60 mm Hg, and he has a diffuse erythematous macular rash on his trunk, abdomen, and legs. Discontinue vancomycin; await culture results and sensitivities before restarting antibiotics C. Slow down the vancomycin infusion rate and premedicate with diphenhydramine D. Obtain a vancomycin skin test Key Concept/Objective: To be able to recognize the red-man syndrome This patient has the characteristic clinical presentation of the vancomycin-related red-man syndrome, which is characterized by hypotension, flushing, erythema, pruritus, urticaria, and pain or muscle spasms of the chest and back. The syndrome is caused by non–IgE-medi- ated histamine release that is more likely with rapid infusion rates (> 10 mg/min).
Attach a monitor purchase 260mg extra super avana visa; confirm asystole 260mg extra super avana visa; administer 40 mg of vasopressin I. The sequence of resuscitation steps in the management of asystole is as follows: activation of EMS; CPR, rhythm evaluation, and asystole confirmation; intubation; I. If asystole persists for more than 10 min despite optimal CPR, oxygenation, ven- tilation, and epinephrine or atropine administration, efforts should stop unless there is hypothermia or drug overdose. A 66-year-old female patient is admitted to the orthopedic surgery service with a left hip fracture. She has a history of hypertension and osteoporosis but is otherwise in good health. She has no history of chest pain, but she says she gets short of breath when she walks about a half mile. She smoked one pack of cigarettes a day for 30 years, but she quit 5 years ago. She is taking an ACE inhibitor for her hyper- tension. Which of the following statements regarding preoperative cardiovascular risk assessment is true? The most important risk factor for cardiac death or complication perioperatively is a recent myocardial infarction B. The most important preoperative use of echocardiography is to assess the degree of systolic dysfunction 10 BOARD REVIEW C. Most patients who do not have an independent clinical need for coronary revascularization can proceed to surgery without further cardiac investigation D. There is good evidence that diastolic dysfunction increases perioper- ative risk significantly Key Concept/Objective: To understand the basic principles of preoperative cardiovascular risk assessment Uncontrolled heart failure is the most important risk factor for cardiac death or com- plications. A history of functional limitation appears to be the most helpful of all the historical points in this assessment.
