You are called into a patient's room by the nurse because blood ...

[asmith134]

You are called into a patient's room by the nurse because blood is spurting from the tracheosto-my site, which was placed 2 weeks ago. The patient is receiving mechanical ventilatory support and has a history of liver failure and CHF.
 
  Which of the following conditions is the most likely cause?
  a. Acute pulmonary edema
  b. Rupture of the innominate artery
  c. Pulmonary hemorrhage
  d. Pneumothorax

Question 2

A patient with acute cardiogenic pulmonary edema (ACPE), as evidenced by pink, frothy secre-tions, arrives in the emergency department (ED) by ambulance with a nonrebreather mask (NRM) at 15 L/min.
 
  An arterial blood gas sample is drawn in the ED while the patient is on the NRM; the values are: pH = 7.50, PaCO2 = 28 mm Hg; PaO2 = 43 mm Hg; SaO2 = 84; HCO3 = 24 mEq/L. After evaluating the situation, the respiratory therapist should suggest which of the following thera-pies?
  a. IPPB with supplemental oxygen
  b. Mask CPAP with supplemental oxygen
  c. Postural drainage to clear the secretions
  d. NIV via nasal mask with postural drainage

[zhanghao]

Answer to Question 1

ANS: B
Rupture of the innominate artery is a potentially serious airway complication and the mortality rate for this condition is high. It usually is seen in the first 3 weeks after a tracheostomy. The immediate indication is blood spurting from the tracheotomy site.

Answer to Question 2

ANS: B
The current recommendation for ACPE is for CPAP to be used initially. NIV should be used only in patients who were hypercapnic and continue to be hypercapnic in spite of the CPAP. This patient is not hypercapnic at this time; therefore, mask CPAP is the appropriate therapy. IPPB is not appropriate because the positive effects of the therapy will be lost after a few minutes off the therapy.

[asmith134]

Thank you

[zhanghao]

No problemo