THURSDAY´S Question Sample!!!

**usmlepack** · 02-08-2007, 08:34 PM

A 21-year-old college student comes to the emergency department because of a 30-minute history of difficulty in breathing, and a sharp left-sided chest pain that came on suddenly when he was walking back to his dormitory after biology class. He says that he is generally very healthy and has never experienced anything like this in the past. He is 188 cm (6 ft 2 in) tall and weighs 70 kg (154 lb). His temperature is 37.0 C (98.6 F), blood pressure is 120/80 mm Hg, pulse is 75/min, and respirations are 22/min. Physical examination shows decreased breath sounds, decreased tactile fremitus, and increased resonance to percussion on the left side. The cardiac examination is normal. You order a chest x-ray and go to see the next patient. You hear a radiology technician call for help as you finally get to sit down to write your notes. You run over to the patient and find that it is your "shortness of breath
and chest pain" patient and that he has not had the chest x-ray yet. He is now cyanotic and has severe dyspnea. Examination shows tracheal deviation and distended neck veins. The most appropriate immediate management is

A. draw an arterial blood gas

B. endotracheal intubation

C. insert a chest tube on the left side

D. insert a needle into the left 2nd intercostal space

E. obtain a chest x-ray at the bedside

FIND THE ANSWER AND MUCH MORE AT:
Mod edit - advertising removed. I've left the questions incase anyone wants to have a stab though.

**dsn** · 02-08-2007, 08:50 PM

I wouldn't know, but what I do know is this: if you're taking arterial blood gas sample, then take the needle off before you take down to your pathology lab for testing! It's dangerous to carry needles around corridors; it's an unacceptable (and unnecessary) risk for lab staff and it's not very pleasant for any one.

**usmlepack** · 02-08-2007, 08:56 PM

Remember the patient is on respiratory distress and you need to ACT NOW.
That´s the key.

**dsn** · 03-08-2007, 12:13 PM

Health and safety first!

**Eponine_hugo** · 03-08-2007, 12:39 PM

I'd go for C but that's a guess based on the fact that he's cyanotic therefore not getting enough O2, right side is normal breathing so am guessing tubing him wont do much good so chest tube into left side seems best. Did I kill him or save him?

**Seamooie** · 22-08-2007, 11:19 AM

I'm going for D

**Bambi** · 22-08-2007, 05:42 PM

It's obviously D!

After D you would insert a chest tube (C) and then you would order a repeat x-ray (E) to check that it is in the proper place and maybe get a blood gas (A). Simple!