A 70-year-old patient is shivering and has chest pain in the PACU following a cholecystectomy. Heart rate is 120 bpm, and blood pressure is 220/120 mmHg. SpO2 is 97% at an FiO2 of 0.4. An ECG shows ST-T wave changes, which are not affected by intravenous administration of nitroglycerin. Which of the following is the most appropriate next step?
(A) injection of sulfur hexafluoride for retinal tamponade
(B) repair of open eye injury
(C) scleral buckling with synthetic bands
(D) strabismus surgery
(E) trabeculectomy for glaucoma
A
A 5-year-old child is brought to the emergency department in considerable respiratory distress. He is sitting leaning forward and drooling. He was well until four hours ago, when temperature increased to 38.9°C and he complained of a sore throat. The most appropriate initial management is to
(A) administer nebulized racemic epinephrine
(B) gently examine the airway with a tongue blade
(C) obtain a lateral radiograph of the neck
(D) perform a rapid induction-intubation sequence
(E) perform inhalation induction without cricoid pressure
(A) causes more hemodynamic stimulation than an oropharyngeal airway
(B) is contraindicated in patients with cervical spine instability
(C) is more easily inserted when cricoid pressure is applied
(D) may serve as a temporary airway in case of a failed rapid sequence intubation
(E) requires administration of a muscle relaxant to avoid laryngospasm during insertion
D
A morbidly obese patient is to undergo gastric stapling during general anesthesia. Following preoxygenation and induction, the oxygen saturation decreases after 40 seconds of laryngoscopy and attempted intubation. The rapid onset of arterial desaturation is most likely due to