Author Question: A 31-year-old woman is admitted to the emergency department following a motor vehicle acci-dent. The ... (Read 79 times)

itsmyluck · **on:** Jul 16, 2018

A 31-year-old woman is admitted to the emergency department following a motor vehicle acci-dent. The paramedics brought her into the ER in respiratory distress.

She was intubated in the field and started on mechanical ventilation as soon as she arrived. Breath sounds were clear on the left and absent on the right. Percussion revealed resonance on the left and hyperresonance on the right. The patient's trachea was shifted to the left. The most likely cause of this patient's clinical presentation is which of the following?
a. Acute respiratory distress syndrome (ARDS)
b. Flail chest
c. Pneumothorax
d. Pleural effusion

Question 2

The respiratory therapist is evaluating the following ventilator flow sheet. The recommendation that is most appropriate in this situation is which of the following?

Time PIP (cm H2O) Pplateau (cm H2O) PEEPE (cm H2O) Exhaled VT (mL) Flow rate (L/min)
0800 35 30 5 1000 60
1000 39 34 5 1000 60
1100 45 39 5 1000 60
1130 50 44 5 1000 60

a. Increase extrinsic positive end-expiratory pressure (PEEPE).
b. Suction the airway.
c. Switch out the heat moisture exchanger (HME).
d. Administer a bronchodilator.

pallen55 · **Reply #1 on:** Jul 16, 2018

Answer to Question 1

ANS: C
Absent breath sounds on the right side with hyperresonance means there is excessive air in the pleural cavity on the right side. A tracheal shift to the left indicates that there is either a right-sided pneumothorax or left-sided atelectasis. The presence of the hyperresonance with the tracheal shift and absent breath sounds points to the pneumothorax.

Answer to Question 2

ANS: A
What is demonstrated here is that there is an increase in the plateau pressure (Pplateau) and this re-flects a decreasing lung compliance or stiffening of the lungs. Adding extrinsic positive end-expiratory pressure (PEEPE) to this patient could result in a decrease in the Pplateau. Since the transairway pressure (PTA) has remained stable over the 3.5 hours, there is no increase in airway resistance and no need to suction the airway, switch out the heat moisture exchanger (HME), or administer a bronchodilator.