acute asthma exacerbation ...next step q - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 06-06-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 591 Times in 355 Posts
Reputation: 601
Default acute asthma exacerbation ...next step q

A 23-year-old woman with a long history of asthma and previous exacerbations requiring intubation is evaluated in the emergency department for a 2-day history of increasing wheezing and dyspnea after the onset of a sore throat. She has a cough productive of small amounts of whitish mucus with some plugs. She has no fever or chills and says that she has used her albuterol inhaler many times in the past day. She had been taking montelukast daily but had not been using her corticosteroid inhaler because she had previously felt well.

On physical examination, she is alert and cooperative but in severe respiratory distress; the blood pressure is 160/80 mm Hg, heart rate is 140/min, and respiration rate is 36/min. She is using accessory muscles of breathing. She has nasal flaring, and chest examination reveals diffuse inspiratory and expiratory wheezes.

Peak expiratory flow rate is 110 L/min; leukocyte count is 16,500/μL. Measurement of arterial blood gases shows a pH of 7.32, PCO2 of 44 mm Hg, and PO2 of 76 mm Hg with the patient breathing oxygen, 5 L/min by nasal cannula. Chest radiograph shows hyperinflation but is otherwise normal.

Intravenous corticosteroid therapy is begun.

Which of the following is the most appropriate next step in this patient's management?

A An anticholinergic agent and a short-acting β-agonist
B Helium combined with oxygen (Heliox)
C Intravenous or inhaled magnesium sulfate
D Prompt intubation
Reply With Quote Quick reply to this message



  #2  
Old 06-06-2012
USMLE Forums Veteran
 
Steps History: 1+CK+CS+3
Posts: 246
Threads: 18
Thanked 142 Times in 86 Posts
Reputation: 152
Default

Ans A the question start with steroid before giving bronchodilator
Mg could be add if no response
Reply With Quote Quick reply to this message
  #3  
Old 06-06-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 591 Times in 355 Posts
Reputation: 601
Default

can i get more expln to your reason, ya its the correct ans. patient is having high PaCO2 with low PaO2, isnt that an indication to intubate ? anything less than 80 PaO2 should mean intubate.???
Reply With Quote Quick reply to this message
 
  #4  
Old 06-06-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,867
Threads: 149
Thanked 2,107 Times in 1,049 Posts
Reputation: 2127
Default

A An anticholinergic agent and a short-acting β-agonist.
They have not been given yet and they provide immediate relief while steroids takes at least 4 hours.
Once anticholinergic agent and a short-acting β-agonist have been tried then only other options are to be considered.
Reply With Quote Quick reply to this message
  #5  
Old 06-06-2012
USMLE Forums Scout
 
Steps History: Not yet
Posts: 21
Threads: 10
Thanked 5 Times in 5 Posts
Reputation: 15
Default

D she is in respiratory acidosis and needs immediate intubation
Reply With Quote Quick reply to this message
  #6  
Old 06-07-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 591 Times in 355 Posts
Reputation: 601
Default

Quote:
Originally Posted by hishamsalahuddi View Post
D she is in respiratory acidosis and needs immediate intubation
i am of the same thought.

please anyone come ahead, and solve this dilemma? patient has indications for intubation ... so why not intubate ?
Reply With Quote Quick reply to this message
  #7  
Old 06-07-2012
USMLE Forums Veteran
 
Steps History: 1+CK+CS+3
Posts: 246
Threads: 18
Thanked 142 Times in 86 Posts
Reputation: 152
Default

Quote:
Originally Posted by tyagee View Post
i am of the same thought.

please anyone come ahead, and solve this dilemma? patient has indications for intubation ... so why not intubate ?
[QUOTE]Once anticholinergic agent and a short-acting β-agonist have been tried then only other options are to be considered.[QUOTE]
Reply With Quote Quick reply to this message
The above post was thanked by:
tyagee (06-07-2012)



Reply

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Acute Cholecystitis Vs Acute Ascending Cholangitis Hohepa USMLE Step 2 CK Forum 2 01-28-2015 04:28 AM
COPD exacerbation...what is the next step ? plz give expln tyagee USMLE Step 2 CK Forum 12 05-28-2012 11:45 PM
Pathophysiology of COPD exacerbation! doxorubicin USMLE Step 1 Forum 7 12-30-2011 07:52 PM
Exacerbation of Woman's Acne! kalsabek USMLE Step 1 Forum 12 10-22-2011 11:53 PM
acute megakaryocytic leukemia or acute lymphoblastic leukemia in Down syndrome patients??? doctorF USMLE Step 1 Forum 6 10-05-2011 09:35 AM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)