Question

A 6'0" 68-year old male, weighing 110 kg arrives in respiratory distress. His RR is 34/min, and has copious pink, frothy secretions. Auscultation reveals inspiratory and expiratory wheezing throughout lung fields. Slight JVD is noted.

The BEST first treatment is:
A) Place pt immediately on noninvasive CPAP + 10 cmH2O
B) Recommend 2L D5W be administered
C) Place pt on Albuterol 15 mg/hr via continuous nebulizer. Consider use of Heliox 80/20 to alleviate Work of Breathing
D) Intubate and place on Pressure Control Mandatory Ventilation

Answer 1

The most appropriate initial treatment for the patient's acute respiratory distress and suspected cardiogenic pulmonary edema is noninvasive ventilation with CPAP, as it can improve oxygenation and reduce the work of breathing. Option A is the best first treatment.

Step-by-step explanation:

The patient is experiencing acute respiratory distress with signs indicating possible pulmonary edema (copious pink, frothy secretions, and respiratory rate of 34/min) as well as potential cardiac issues (slight JVD). The symptoms suggest that noninvasive ventilation with CPAP (Continuous Positive Airway Pressure) may be the best first treatment to improve oxygenation and reduce the work of breathing, without delaying intubation if necessary. Therefore, option A) Place pt immediately on noninvasive CPAP + 10 cmH2O is the best initial treatment.

While corticosteroids and bronchodilators such as albuterol can be helpful in certain types of respiratory distress, they may not be the best initial choice for suspicion of cardiogenic pulmonary edema. If the patient's condition does not improve with CPAP or deteriorates further, more invasive measures like intubation and mechanical ventilation can be considered.