Acute asthma exacerbation - 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 08-09-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 588 Times in 354 Posts
Reputation: 598
Lungs Acute asthma exacerbation

The mother of a 3-year-old girl brings her child to the emergency room (ER). The child is anxious and tired appearing, is using accessory muscles of respiration, and cannot speak more than one word between breaths. Pulse oximetry shows 65% oxygen saturation on room air. This increases to 85% oxygen saturation on 100% oxygen via face mask. Her vital signs are as follows: temperature (T), 37.1C (98.8F); blood pressure (BP), 120/60 mm Hg; heart rate (HR), 180 beats/minute; and respiration rate (RR), 14 breaths/minute. Her lips and fingertips have a dusky bluish discoloration. Rib retractions are seen. There is poor air movement but no wheeze on chest auscultation. The chest X-ray shows no foreign object obstructing the airway. What is the most important next step in management of the child's impaired respiratory status?

A. Continuous inhaled albuterol
B. Intramuscular epinephrine
C. Intravenous (IV) methylprednisolone
D. Mechanical ventilation
E. Oral prednisone
plz give reason along
Reply With Quote Quick reply to this message



  #2  
Old 08-09-2012
K06100's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 730
Threads: 90
Thanked 456 Times in 289 Posts
Reputation: 466
Default

i think A........i think 1st step--O2
2nd step-nebulised albuterol...add ipratropium if no resp after 1st dose
3rd-corticosteroids
4th-if no resp to steroids and albuterol-mechanical ventilation
__________________
Try Not To Become A Man Of Success But A Man Of Value.
Reply With Quote Quick reply to this message
  #3  
Old 08-09-2012
USMLE Forums Guru
 
Steps History: Not yet
Posts: 304
Threads: 76
Thanked 73 Times in 51 Posts
Reputation: 83
Default

It is severe asthma
so 1st step is oxygen then short beta 2 agonist
so I go with A ...
Reply With Quote Quick reply to this message
 
  #4  
Old 08-09-2012
USMLE Forums Guru
 
Steps History: 1 + CS
Posts: 405
Threads: 55
Thanked 528 Times in 155 Posts
Reputation: 538
Default

D) Cyanosis + loss of wheezing (the most serious one) means patient is crashing - starting with mechanical ventilation will be a good step for this one.
Reply With Quote Quick reply to this message
  #5  
Old 08-09-2012
USMLE Forums Addict
 
Steps History: 1+CK+CS+3
Posts: 151
Threads: 48
Thanked 111 Times in 60 Posts
Reputation: 121
Default

D...well stated by donofitaly....this is even life threatening asthma...speaking in monosyllables, cyanosis, loss of wheezing...U have to assist her breathing...
Reply With Quote Quick reply to this message
  #6  
Old 08-09-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 588 Times in 354 Posts
Reputation: 598
Default

Quote:
Originally Posted by stfidel View Post
D...well stated by donofitaly....this is even life threatening asthma...speaking in monosyllables, cyanosis, loss of wheezing...U have to assist her breathing...
I thought that but answer is albuterol. No good Reason around
Reply With Quote Quick reply to this message
  #7  
Old 08-09-2012
USMLE Forums Addict
 
Steps History: 1+CK+CS+3
Posts: 151
Threads: 48
Thanked 111 Times in 60 Posts
Reputation: 121
Default

Whats the source of the question.....Albuterol doesnt sound right..
Reply With Quote Quick reply to this message
  #8  
Old 08-09-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 851
Threads: 88
Thanked 710 Times in 380 Posts
Reputation: 720
Default

I will go with D .the patient is not able to make respiratory drive as seen by poor air movements.She seems to have respiratory distress and not asthma.She needs mechanical ventilation
Reply With Quote Quick reply to this message
  #9  
Old 08-10-2012
XpaezX's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,216
Threads: 41
Thanked 1,327 Times in 711 Posts
Reputation: 1342
Default

The patient is crashing, she has cyanosis, loss of wheezing and she is getting tired of brearhing (14, instead of tachypnea) , inany hospital settings with this scenario you have to intubate, her O2 did increased to 85 but thats still low and she still has cyanosis... We must intubate
Reply With Quote Quick reply to this message
  #10  
Old 08-10-2012
K06100's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 730
Threads: 90
Thanked 456 Times in 289 Posts
Reputation: 466
Default

Quote:
Originally Posted by XpaezX View Post
We must intubate
i think intubation is done when airway is not patent.....here the airway is fine.....

Quote:
Originally Posted by Tyagee View Post
There is poor air movement but no wheeze on chest auscultation. The chest X-ray shows no foreign object obstructing the airway
__________________
Try Not To Become A Man Of Success But A Man Of Value.

Last edited by K06100; 08-10-2012 at 06:35 AM.
Reply With Quote Quick reply to this message
The above post was thanked by:
XpaezX (08-10-2012)
  #11  
Old 08-10-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 588 Times in 354 Posts
Reputation: 598
Default

we start with albuterol as initial rx in acute asthma exacerbation ... isnt ?

i have such q early which just tell what to do first in such situations and guess wht, every time i press on to intubation option...its hurting now
Reply With Quote Quick reply to this message
  #12  
Old 08-10-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,867
Threads: 149
Thanked 2,104 Times in 1,049 Posts
Reputation: 2124
Default

Quote:
Originally Posted by tyagee View Post
The mother of a 3-year-old girl brings her child to the emergency room (ER). The child is anxious and tired appearing, is using accessory muscles of respiration, and cannot speak more than one word between breaths. Pulse oximetry shows 65% oxygen saturation on room air. This increases to 85% oxygen saturation on 100% oxygen via face mask. Her vital signs are as follows: temperature (T), 37.1C (98.8F); blood pressure (BP), 120/60 mm Hg; heart rate (HR), 180 beats/minute; and respiration rate (RR), 14 breaths/minute. Her lips and fingertips have a dusky bluish discoloration. Rib retractions are seen. There is poor air movement but no wheeze on chest auscultation. The chest X-ray shows no foreign object obstructing the airway. What is the most important next step in management of the child's impaired respiratory status?

A. Continuous inhaled albuterol won't help since no wheeze
B. Intramuscular epinephrine won't help since no wheeze
C. Intravenous (IV) methylprednisolone takes time (hours) and won't help since no wheeze
D. Mechanical ventilation the answer since he is exhausted and needs it now!
E. Oral prednisone takes a lot of time and won't help since no wheeze
plz give reason along
He is not ventilating because he has diaphragmatic problem and has exhausted his accessory muscles of respiration
...............
Reply With Quote Quick reply to this message
  #13  
Old 09-10-2012
ratung's Avatar
USMLE Forums Scout
 
Steps History: Not yet
Posts: 27
Threads: 1
Thanked 0 Times in 0 Posts
Reputation: 10
Default

since when have alive patients started getting intubated!!!lol!u have to anesthetize and then intubate!u anesthetize and she dies anyway
Reply With Quote Quick reply to this message
  #14  
Old 09-10-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,867
Threads: 149
Thanked 2,104 Times in 1,049 Posts
Reputation: 2124
Default

Quote:
Originally Posted by ratung View Post
since when have alive patients started getting intubated!!!lol!
Because there won't be much point in intubating dead patients........will it?
__________________
A man doesn't know what he knows until he knows what he doesn't know.
What is man? He's just a collection of chemicals with delusions of grandeur.
Reply With Quote Quick reply to this message
  #15  
Old 09-12-2012
ratung's Avatar
USMLE Forums Scout
 
Steps History: Not yet
Posts: 27
Threads: 1
Thanked 0 Times in 0 Posts
Reputation: 10
Default

U still have to anesthetize before that and do not go on about intubating patients live in an emergency setting!!!even trachestomy is done after anesthetizing!in this u anesthetize she will go in a deeper respiratory depression
Reply With Quote Quick reply to this message






Reply

Tags
Emergency-Medicine, Pulmonology-, Step-2-Questions

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
Colonoscopy in acute exacerbation of ulcerative colitis ? tyagee USMLE Step 2 CK Forum 5 06-24-2012 10:46 AM
acute asthma exacerbation ...next step q tyagee USMLE Step 2 CK Forum 6 06-07-2012 04:52 AM
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

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)