Author Question: While discussing the care of a morbidly obese patient with hemodynamic instability, the physi-cian ... (Read 28 times)

geoffrey · **on:** Jul 16, 2018

While discussing the care of a morbidly obese patient with hemodynamic instability, the physi-cian expresses concern regarding aggressive IV fluid therapy.

Which patient pathologies associated with obesity could be an explanation?
1. Decreased preload
2. Myocardial hypertrophy
3. Decreased heart-wall compliance
4. Reduces heart chamber volumes
a. 1 and 3 only
b. 1, 2, and 3 only
c. 3 and 4 only
d. 2, 3, and 4 only

Question 2

You are taking care of a trauma patient in the ICU. Following placement of a chest tube, there is a large amount of air that continues to exit the chest tube in a synchronized pattern with positive pressure ventilation. What do you suspect?

a. Inappropriate ventilator settings
b. Bronchial injury
c. Correct placement of the chest tube
d. Endotracheal tube cuff leak

samiel-sayed · **Reply #1 on:** Jul 16, 2018

Answer to Question 1

ANS: D
Myocardial hypertrophy and diastolic dysfunction are the results of these alterations, eventually leading to heart failure, arrhythmias, or sudden cardiac arrest. Myocardial hypertrophy and the consequently reduced heart-wall compliance, as well as reduced heart chamber volumes, are re-sponsible for poor tolerance of IV fluids in these patients.

Answer to Question 2

ANS: B
The presence of bronchial injury should be suspected when, after the placement of a chest tube for pleural drainage, large amounts of air continue to exit the chest tube in a synchronized pattern with positive pressure ventilation.