A 62-year-old man was brought to the
emergency room with acute shortness of breath.
He was hypertensive, on
candesartan, and suffered ischemic cerebral infarction 12 months earlier, with
residual impairment of his swallowing.
Since then he was being fed via a
gastrostomy tube.
His daughter said that he vomited
twice, 4 hours before the onset of breathlessness.
On examination he was tachypneic and
hypoxemic. Blood pressure was 150/90, pulse was 110/minute and temperature was 38°C .
Auscultation of the chest revealed
bilateral crackles and rhonchi.
Chest x-ray showed bilateral patchy
infiltrates.
Which of the following is indicated
in the management of this patient's acute illness?
A- Prophylactic
antibiotics
B- Intravenous
hydrocortisone
C- Supplemental Oxygen
D- Intravenous furosemide
E- Inhaled bronchodilator
Check correct answer and explanation
below:
Correct answer is C
This patient's presentation strongly
suggested acute gastric content aspiration, since his swallowing is impaired,
and the event immediately followed bouts of vomiting.
Monitoring Oxygen saturation is essential
as assisted ventilation may be required.
There is no evidence that
corticosteroids are beneficial, nor antibiotics will change the outcome (except
when there is evidence of secondary bacterial infection).
Diuretics are not indicated here.
Instead, intravenous fluids should be administered, because of the
intravascular fluid loss through disrupted alveolar capillary membrane.
Inhaled has no benefit in relieving
symptoms nor improving Oxygen saturation.
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