CEN Respiratory Emergencies 1 — Questions and Answers
Question 1: A patient with asthma is in severe bronchospasm and is not responding to nebulized albuterol. What is the next most appropriate pharmacological intervention?
- Oral prednisone 40 mg
- IV magnesium sulfate 2 g over 20 minutes (Correct answer)
- Inhaled ipratropium bromide only
- Subcutaneous terbutaline
Correct answer: IV magnesium sulfate 2 g over 20 minutes
IV magnesium sulfate causes bronchial smooth muscle relaxation and is indicated for severe asthma exacerbations not responding to standard beta-agonist therapy.
Question 2: A patient presents with sudden pleuritic chest pain and absent breath sounds on the left side. Tracheal deviation is noted to the right. What is the priority intervention?
- Obtain a chest X-ray immediately
- Administer high-flow oxygen and prepare for needle thoracostomy (Correct answer)
- Insert a chest tube at the fourth intercostal space
- Start broad-spectrum antibiotics
Correct answer: Administer high-flow oxygen and prepare for needle thoracostomy
The presentation describes a tension pneumothorax, a life-threatening emergency requiring immediate needle thoracostomy at the second intercostal space, midclavicular line, before imaging.
Question 3: Which ABG result is most consistent with acute respiratory acidosis?
- pH 7.52, PaCO2 28, HCO3 22
- pH 7.28, PaCO2 58, HCO3 24 (Correct answer)
- pH 7.38, PaCO2 40, HCO3 24
- pH 7.30, PaCO2 35, HCO3 16
Correct answer: pH 7.28, PaCO2 58, HCO3 24
A low pH with an elevated PaCO2 and normal bicarbonate (no metabolic compensation yet) indicates acute respiratory acidosis.
Question 4: A drowning victim is brought in apneic and pulseless. After resuscitation, they regain a pulse but remain comatose with SpO2 88% on room air. What condition should be anticipated?
- Pulmonary embolism
- Aspiration pneumonia
- Acute respiratory distress syndrome (ARDS) (Correct answer)
- Spontaneous pneumothorax
Correct answer: Acute respiratory distress syndrome (ARDS)
Near-drowning victims are at high risk for developing ARDS due to aspiration of fluid causing diffuse alveolar damage and refractory hypoxemia.
Question 5: Which finding on a chest X-ray is most consistent with a massive pleural effusion?
- Tracheal deviation toward the affected side with opacification (Correct answer)
- Bilateral fluffy infiltrates
- Tracheal deviation away from the affected side with opacification
- Air-fluid levels in both lung fields
Correct answer: Tracheal deviation toward the affected side with opacification
A massive pleural effusion causes opacification of the hemithorax with tracheal deviation toward the affected side due to atelectasis, unlike tension pneumothorax where the trachea deviates away.
Question 6: A patient with COPD and a history of CO2 retention presents in respiratory distress. Which oxygen delivery target is most appropriate?
- SpO2 98–100% via non-rebreather mask
- SpO2 88–92% via controlled oxygen delivery (Correct answer)
- SpO2 95% via simple face mask
- Immediate intubation without supplemental oxygen
Correct answer: SpO2 88–92% via controlled oxygen delivery
COPD patients with chronic hypercapnia can lose their hypoxic drive to breathe; targeting SpO2 88–92% prevents both hypoxia and CO2 retention.
CEN Respiratory Emergencies 1
A patient with asthma is in severe bronchospasm and is not responding to nebulized albuterol.
What is the next most appropriate pharmacological intervention?