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.