A 27-year-old man visits the emergency department complaining of sudden, intense shortness… — USMLE Step 2 CK

A 27-year-old man visits the emergency department complaining of sudden, intense shortness of breath and chest tightness that began one hour ago. He has a known history of mild persistent asthma but has not used his maintenance inhaler for the past month. His temperature is $37.2^\circ\text{C}$ ( $99.0^\circ\text{F}$ ), blood pressure is $138/82\text{ mmHg}$ , pulse is $115/\text{min}$ , and respiratory rate is $26/\text{min}$ . Pulse oximetry shows an oxygen saturation of $93\%$ on room air. Physical examination reveals an anxious patient sitting upright. Diffuse expiratory wheezes are heard bilaterally with a prolonged expiratory phase. There is no lower extremity edema or jugular venous distention. A point-of-care arterial blood gas analysis on room air shows a pH of $7.50$ , $\text{PaCO}_2$ of $27\text{ mmHg}$ , and $\text{PaO}_2$ of $68\text{ mmHg}$ . A portable chest radiograph displays hyperinflation of both lungs but no focal opacities. Which of the following is the most appropriate next step in the management of this patient?

A
Give intravenous loop diuretics
B
Perform rapid sequence intubation
Provide inhaled short-acting beta-agonists and oral prednisoneCevap
D
Prescribe broad-spectrum antipseudomonal antibiotics
E
Start therapeutic systemic anticoagulation

Cevap

Provide inhaled short-acting beta-agonists and oral prednisone

The patient is experiencing an acute asthma exacerbation. First-line medical therapy for a mild to moderate exacerbation includes the immediate administration of short-acting beta-agonists (such as albuterol) to reverse acute bronchoconstriction, along with systemic corticosteroids (such as oral prednisone) to decrease airway inflammation and prevent relapse. The patient is protecting his airway and effectively oxygenating/ventilating, making non-invasive medical management the correct choice.

Adım Adım Çözüm

Assess the clinical presentation and physical examination findings.

The patient has acute dyspnea, tachycardia, diffuse expiratory wheezing, and a history of asthma, strongly suggesting an acute asthma exacerbation.

To establish the primary diagnosis and rule out alternative causes of dyspnea such as heart failure or pneumonia.

Analyze the arterial blood gas results to assess exacerbation severity.

The ABG shows a pH of 7.50 and a PaCO2 of 27 mmHg, confirming primary respiratory alkalosis without signs of respiratory muscle fatigue.

To determine if the patient is progressing toward impending respiratory failure, which would be indicated by a normal or elevated PaCO2 (respiratory acidosis).

Determine the most appropriate initial pharmacological intervention.

Standard first-line therapy includes a short-acting bronchodilator to relieve bronchospasm and a systemic corticosteroid to treat the underlying inflammation.

These medications address the acute pathophysiology of an asthma exacerbation and prevent further clinical deterioration.

Anahtar Kavram

Management of acute asthma exacerbation and interpretation of associated acid-base changes.

Tahmini Süre:1m 0s

Soru

Cevap

Adım Adım Çözüm

Anahtar Kavram

Sık Yapılan Hatalar

Konular

Bu konudan daha fazla soru