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Questions and Answers
What is your initial action for a 37-year-old man in profound respiratory distress?
What is your initial action for a 37-year-old man in profound respiratory distress?
- Administer albuterol by small volume nebulizer
- Administer oxygen by non-rebreather mask at 15 L/min (correct)
- Request a stat portable A-P chest radiograph
- Administer oxygen by nasal cannula at 5L/min
- Perform arterial puncture
Which assessments would be included for Mr. Rodriguez? (Select as many as applicable)
Which assessments would be included for Mr. Rodriguez? (Select as many as applicable)
- Serum electrolytes (correct)
- Sputum culture
- Arterial blood gas (correct)
- Urinalysis (correct)
- Chest x-ray
- Complete blood count (correct)
- Hemoximetry (correct)
What recommendation would you now make to the physician?
What recommendation would you now make to the physician?
- Continue current therapy
- Perform endotracheal intubation (correct)
- Initiate hyperbaric oxygen therapy
- Administer racemic epinephrine by small volume nebulizer STAT
- Administer albuterol by small volume nebulizer STAT
Which assessments would you include in your re-evaluation of the patient's condition? (Select as many as applicable)
Which assessments would you include in your re-evaluation of the patient's condition? (Select as many as applicable)
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Based on your findings, which recommendation would you now make to the physician?
Based on your findings, which recommendation would you now make to the physician?
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Study Notes
Patient Overview
- Patient: Mr. Rodriguez, 37 years old, 5'9" (175 cm), 170 lb (77 kg), rescued from a burning barn.
- Emergency department assignment at a 420 bed medical center; shift from 7:00 AM to 7:00 PM.
Initial Assessment Findings
- Patient exhibits tachypnea, tachycardia, and profound respiratory distress with audible wheezes.
- Immediate action involves administering oxygen with a non-rebreather mask at 15 L/min.
Key Assessment Components
- Sensorium: Conscious, alert, and oriented.
- Respiratory pattern: 45 breaths/min with intercostal retractions, use of accessory muscles, and high-pitched inspiratory sounds.
- Chest movement: Notable bilateral movement.
- Posture: High Fowler position indicating distress.
- Heart rate: 140 beats/min.
- Skin color: Cherry-red appearance of lips and eyelids.
- General appearance: Anxious demeanor along with first-degree burns on the face and neck.
Recommendations for Management
- Physician instructed to perform endotracheal intubation to secure the airway.
- After 30 minutes, reevaluation made, with multiple assessments including:
- Complete blood count (RBC 4.9 mill/cu mm, Hb 14.9 g, Hct 45%, WBC 5,800/cu mm).
- Arterial blood gas: pH 7.51, PaCO2 30 torr, PaO2 400 torr, HCO3 28 mEq/L.
- Vital signs: Temperature 37.5°C (99.5°F), pulse 110/min, respirations 27/min, BP 130/88 mmHg.
- Hemoximetry results: O2 Hb 70%, COHb 30%.
Follow-Up Assessments
- Diagnostic chest percussion revealed resonant sounds bilaterally.
- Chest auscultation showed bilateral vesicular sounds and a few inspiratory crackles.
- Capillary refill test indicated normal perfusion (color returns within seconds).
- Tracheal position remained midline, with sensorium steady (conscious and oriented).
- Breathing pattern stable, showing bilateral chest expansion without retractions.
Final Recommendations
- Based on findings, maintaining current therapy was recommended, continuing to monitor the patient's respiratory status and overall condition.
Simulation Conclusion
- End of simulation process; key elements detailed for patient assessment and management in emergency scenarios.
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