A patient seen in the emergency department exhibits paralysis of ...

[Redwolflake15]

A patient seen in the emergency department exhibits paralysis of the lower extremities that is getting progressively worse.
 
  Vital capacity is 6 mL/kg, maximum inspiratory pressure (MIP) is 17 cm H2O, and oxygen sat-uration measured by pulse oximeter (SpO2) is 89. Arterial blood gases are pending. The physi-cian suspects Guillain-Barr syndrome. The most appropriate action at this time is which of the following?
  a. Intubate and mechanically ventilate.
  b. Place patient on a nonrebreather mask.
  c. Initiate continuous positive airway pres-sure.
  d. Initiate noninvasive positive pressure ven-tilation.

Question 2

Which of the following values are indicative of acute respiratory failure and the need for venti-latory support?
 
  1. Maximum inspiratory pressure (MIP) = 38 cm H2O.
  2. Vital capacity (VC) = 650 mL for a 70 kg male.
  3. Alveolar-to-arterial partial pressure of oxygen P(Aa)O2 = 150 on 100 oxygen.
  4. Maximum expiratory pressure (MEP) = 25 cm H2O.
  a. 1 and 2 only
  b. 2 and 4 only
  c. 1 and 3 only
  d. 3 and 4 only

[kaykay69]

Answer to Question 1

ANS: A
This patient's maximum inspiratory rate (MIP) and vital capacity (VC) measurements are both critical. Since the patient has a progressive neuromuscular disease with these critical values and a below normal pulse oximetry reading, this patient should be intubated and mechanically venti-lated before the patient develops an acute situation. Placing the patient on a nonrebreather mask or initiating continuous positive airway pressure (CPAP) will not address the fact that the neu-romuscular disease is now beginning to affect this patient's ventilator muscle strength. Since protection of the airway may become an issue, invasive ventilation would be the most appropriate action.

Answer to Question 2

ANS: B
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 H2O.

[Redwolflake15]

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