A 28-year-old male has arrived in the emergency department following a motor vehicle accident.He has a Glasgow Coma Score of 14.Chest X-ray reveals five ribs broken anteriorly in two areas each.Physical assessment reveals paradoxical movement of the chest.Breath sounds are diminished and the trachea is midline.Arterial blood gas on nonrebreather mask is: pH 7.53,partial pressure of carbon dioxide (PₐCO₂)is 25 mm Hg,partial pressure of oxygen (PₐO₂)is 59 mm Hg,arterial oxygen saturation (SₐO₂)93%,bicarbonate (HCO₃⁻)23 mEq/L.The respiratory therapist should recommend which of the following for this patient?
A) Noninvasive positive pressure ventilation (NIV) with supplemental oxygen
B) Intubation with volume-controlled continuous mandatory ventilation (VC-CMV) with positive end-expiratory pressure (PEEP)
C) Mask continuous positive airway pressure (CPAP) with supplemental oxygen
D) Intubation with CPAP and pressure support

Question

Quizplus · Accepted Answer

The arterial blood gas shows that the patient is ventilating,as evidenced by the partial pressure of carbon dioxide (PₐCO₂)of 25 mm Hg.Therefore,this patient does not need to be intubated and ventilated at this time.This also means that the patient does not require noninvasive positive pressure ventilation (NIV).The patient does have an oxygenation problem,as evidenced by the partial pressure of oxygen (PₐO₂)of 59 mm Hg while on a nonrebreather mask.This is an indication for continuous positive airway pressure (CPAP).

A 28-Year-Old Male Has Arrived in the Emergency Department Following