USMLE Forum Archives - USMLE Step 3 - ER: Next best step
ER: Next best step
harry206 - 06-03-09 09:29
You are called emergently to the medical floor where a 66-year-old man was found to be minimally
responsive. His past medical history is unclear but his arm band lists allergies to penicillin and sulfa
medications. On arrival, chest compressions are being performed and 2 operators are mask
ventilating the patient. Evaluation with an electrocardiogram reveals sinus tachycardia and the
diagnosis of pulseless electrical activity is made. Volume is infused and compressions are continued.
The patient remains apneic, so mask ventilation continues. During masking, the patient appears to
regurgitate large volumes of gastric contents. The most appropriate immediate next step in the
management of this patient is to
harry206 - 06-03-09 09:29
You are called emergently to the medical floor where a 66-year-old man was found to be minimally
responsive. His past medical history is unclear but his arm band lists allergies to penicillin and sulfa
medications. On arrival, chest compressions are being performed and 2 operators are mask
ventilating the patient. Evaluation with an electrocardiogram reveals sinus tachycardia and the
diagnosis of pulseless electrical activity is made. Volume is infused and compressions are continued.
The patient remains apneic, so mask ventilation continues. During masking, the patient appears to
regurgitate large volumes of gastric contents. The most appropriate immediate next step in the
management of this patient is to
The correct answer and explanation will be available after you answer.
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#20
Re: ER: Next best step r4321qa - 02-17-10 09:08 My answer is: a.
in practice first step is cease mask ventilaiton, giving lateral decubitus position and suction the mouth to prepare patient for intubation because patient level of conciousness is low. Then, after clearing the mouth to provide a good field of view, perform intubation and secure the airway of patient. Before starting to ventilation we should suction the airway from inside of endotracheal tube to clear the airway of possible aspiration following voimiting. and at the end starting to ventilation again with 100% oxygentill patient get stable in few minute
#27
Re: ER: Next best step babbu5508 - 08-31-10 11:44 My answer is: d.
d. intubate the trachea and suction the airway as without this, the further efforts would be futile as the aspirated contents block airway..and prevent air entry
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