Skip to Main Content

++

Chapter 23. Patient with Deadly Asthma Requires Intubation

++
++
++

Hypotension following RSI facilitated tracheal intubation of the deadly asthmatic may be due to all of the following EXCEPT

++
++
++

A. increased mean intrathoracic pressure associated with positive pressure ventilation

++
++

B. hypovolemia related to reduced oral intake pre-presentation

++
++

C. acute respiratory acidosis

++
++

D. reduced systemic vascular resistance due to succinylcholine

++
++

E. an acute tension pneumothorax

+
++

(D) While an increase in mean intrathoracic pressure, tension pneumothorax, hypovolemia, and acute respiratory acidosis may cause hypotension, succinylcholine does not reduce systemic vascular resistance and decrease blood pressure.

++
++
++

All of the following are true with respect to the pharmacologic management of asthma in the peri-intubation period EXCEPT

++
++
++

A. IV magnesium has been shown to decrease the need for intubation

++
++

B. antimuscarinics such as glycopyrrolate have been shown to increase the viscosity of bronchial secretions, increase the incidence of mucous plugging, and should not be used in acute severe asthma

++
++

C. the evidence clearly supports the use of lidocaine in acute severe asthma

++
++

D. ketamine is the induction drug of choice in acute severe asthma

++
++

E. IV magnesium in high doses leads to skeletal muscle weakness.

+
++

(C) While there is evidence to support the use of magnesium, ketamine, and anticholinergics with respect to the pharmacologic management of asthma in the peri-intubation period, there is no evidence to support the use of lidocaine in acute severe asthma.

++
++
++

Which of the following best characterizes the best way to mechanically ventilate an intubated patient with acute severe asthma?

++
++
++

A. large tidal volumes and low ventilation rates

++
++

B. small tidal volumes and low peak flow rates

++
++

C. large tidal volumes and low peak flow rates

++
++

D. small tidal volumes and high peak flow rates

++
++

E. large tidal volumes and high peak flow rates

+
++

(D) The best way to mechanically ventilate an intubated patient with acute severe asthma is to use small tidal volumes and high peak flow rates.

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.