Author Question: A 28-year-old man with botulism poisoning is beginning to develop progressive paralysis. The ... (Read 7 times)

mpobi80 · **on:** Jul 16, 2018

A 28-year-old man with botulism poisoning is beginning to develop progressive paralysis. The respiratory therapist has been monitoring the patient's MIP and VC every 2 hours.

The most recent results show that the patient continues to deteriorate: MIP = 27 cm H2O, VC = 32 mL/kg. Which of the following could be appropriately recommended?
a. Gastric lavage
b. Oxygen therapy
c. Medication to reverse the paralysis
d. Mechanical ventilatory support

Question 2

Which of the following are goals of mechanical ventilation?

1. To provide support to the pulmonary system to maintain an adequate level of alveolar ventila-tion
2. To reduce the WOB until the cause of respiratory failure can be eliminated
3. To restore ABG levels to normal
4. To prevent or treat atelectasis with adequate end-inspiratory lung inflation
a. 1 and 2 only
b. 1 and 3 only
c. 1, 2, and 3 only
d. 1, 2, and 4 only

ciecieme · **Reply #1 on:** Jul 16, 2018

Answer to Question 1

ANS: D
The critical values for the parameters listed are: maximum inspiratory pressure (MIP) 20 to 0; vital capacity (VC) <10-15 ml>450 on O2; and maximum expiratory pressure (MEP) <40 support.

Answer to Question 2

ANS: D
Physiological Objectives
1. Support or manipulate pulmonary gas exchange:
Alveolar ventilationAchieve eucapnic ventilation or allow permissive hypercapnia (Note: Permissive hypercapnia sometimes is required in the ventilation of patients with asthma, acute lung injury ALI, or acute respiratory distress syndrome ARDS to protect the lung by avoiding high ventilating volumes and pressures.)
Alveolar oxygenationMaintain adequate oxygen delivery (CaO2 Cardiac output).
2. Increase lung volume:
Prevent or treat atelectasis with adequate end-inspiratory lung inflation.
Restore and maintain an adequate functional residual capacity (FRC).
3. Reduce the work of breathing.
Clinical Objectives
1. Reverse acute respiratory failure.
2. Reverse respiratory distress.
3. Reverse hypoxemia.
4. Prevent or reverse atelectasis and maintain FRC.
5. Reverse respiratory muscle fatigue.
6. Permit sedation or paralysis (or both).
7. Reduce systemic or myocardial oxygen consumption.
8. Minimize associated complications and reduce mortality.