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Chapter 23. Patient with Deadly Asthma Requires Intubation
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Hypotension following RSI facilitated tracheal intubation of the deadly asthmatic may be due to all of the following EXCEPT
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A. increased mean intrathoracic pressure associated with positive pressure ventilation
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B. hypovolemia related to reduced oral intake pre-presentation
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C. acute respiratory acidosis
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D. reduced systemic vascular resistance due to succinylcholine
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E. an acute tension pneumothorax
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(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.
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All of the following are true with respect to the pharmacologic management of asthma in the peri-intubation period EXCEPT
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A. IV magnesium has been shown to decrease the need for intubation
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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
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C. the evidence clearly supports the use of lidocaine in acute severe asthma
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D. ketamine is the induction drug of choice in acute severe asthma
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E. IV magnesium in high doses leads to skeletal muscle weakness.
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(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.
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Which of the following best characterizes the best way to mechanically ventilate an intubated patient with acute severe asthma?
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A. large tidal volumes and low ventilation rates
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B. small tidal volumes and low peak flow rates
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C. large tidal volumes and low peak flow rates
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D. small tidal volumes and high peak flow rates
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E. large tidal volumes and high peak flow rates
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(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.