year old man was admitted to the ICU for a COPD exacerbation. He was intubated earlier in the day. Initially after being intubated his static pressure was 23 cm H2o and peak pressure 47 cm H20. The APRN is notified that currently his peak pressure has risen to 62 cm H20 and the static pressure is 42 cm H20. His heart rate has increased from 88 to 112beats / minute and his blood pressure has decreased from 112/88 to 92/ 72. He has decreased breath sounds on the left side. What management steps should you institute at this point?
Selected Answer: At this point, consider initiating the patient on CXR/ spiral CT with contrast, and if necessary, with labs drawn in order to determine the cause of the observed abnormal vital signs as well as the newly decreased breath sounds registered on his left side.
Correct Answer: A chest X-ray should be obtained to look for evidence of a pneumothorax, new pleural effusion, developing ARDS. Examine the patient for any abdominal distention. If the patient becomes hemodynamically unstable and there is high index of suspicion for a tension pneumothorax, a large bore needle should be placed into the second intercostal space along the mid-clavicular line to decompress the pneumothorax. Chest tube placement would be indicated after initial needle placement for decompression. Response Feedback: [None Given]
A 59 year old man was admitted to the ICU for a COPD exacerbation. He was intubated earlier in the day. Initially after being intubated his static pressure was 23 cm H2o and peak pressure 47 cm H20. The APRN is notified that currently his peak pressure has risen to 62 cm H20 and the static pressure is 42 cm H20. His heart rate has increased from 88 to 112beats / minute and his blood pressure has decreased from 112/88 to 92/ 72. He has decreased breath sounds on the left side. What management steps should you institute at this point?
Selected Answer: At this point, consider initiating the patient on CXR/ spiral CT with contrast, and if necessary, with labs drawn in order to determine the cause of the observed abnormal vital signs as well as the newly decreased breath sounds registered on his left side.
Correct Answer: A chest X-ray should be obtained to look for evidence of a pneumothorax, new pleural effusion, developing ARDS. Examine the patient for any abdominal distention. If the patient becomes hemodynamically unstable and there is high index of suspicion for a tension pneumothorax, a large bore needle should be placed into the second intercostal space along the mid-clavicular line to decompress the pneumothorax. Chest tube placement would be indicated after initial needle placement for decompression. Response Feedback: [None Given]
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