Match each acute clinical presentation to the most appropriate initial management step or targeted therapeutic intervention.
- A 45-year-old male with refractory vomiting, blood pressure of 90/60 mm Hg, and a pH of 7.52.Intravenous 0.9% sodium chloride
- A 52-year-old female with lethargy, peaked T waves on ECG, and a serum potassium of 7.2 mEq/L.Intravenous calcium gluconate
- A 65-year-old male with a COPD exacerbation, pH of 7.25, pCO2 of 65 mm Hg, and persistent distress despite bronchodilators.Noninvasive positive pressure ventilation
- A 28-year-old female with tinnitus, tachypnea, respiratory alkalosis, and an anion gap metabolic acidosis.Intravenous sodium bicarbonate
Answer
The vomiting patient requires 0.9% sodium chloride; the hyperkalemic patient requires calcium gluconate; the acidotic COPD patient requires noninvasive positive pressure ventilation; and the salicylate toxicity patient requires sodium bicarbonate.
Each presentation requires a highly specific initial intervention targeting the underlying pathophysiology: volume and chloride repletion for contraction alkalosis, cardiac membrane stabilization for severe hyperkalemia, ventilatory assistance for decompensated COPD, and urine alkalinization for salicylate clearance.
Step-by-Step Solution
Key Concept
Recognition and acute management of life-threatening internal medicine emergencies including severe electrolyte derangements, mixed acid-base disorders, and acute respiratory failure.