A 35-year-old woman with systemic lupus erythematosus is admitted to the critical care unit following sudden onset of severe chest pain. Examination shows tachycardia, hypotension, pulmonary edema, and a blowing systolic murmur in the left parasternal region. The most appropriate management is
(A) aerosol administration of terbutaline
(B) intravenous infusion of phenylephrine and nitroglycerin
(C) intravenous infusion of esmolol
(D) intravenous infusion of epinephrine and nitroprusside
(E) volume loading with lactated Ringer's solution
A 68-year-old patient is undergoing total hip replacement during general anesthesia using positive pressure ventilation and neuromuscular blockade. Intraoperative monitoring shows a gradual decrease in end-tidal CO2, an increase in exhaled tidal volume, and an increase in measured FiO2. Which of the following is the most likely cause of these changes?
(A) Air entrainment around a deflated endotracheal tube cuff
(B) Channeling of the exhaled air through the carbon dioxide canister
(C) Fat embolism
(D) Inadequate muscle relaxation with spontaneous patient ventilation
A 39-year-old patient with insulin-dependent diabetes mellitus receives thiopental 250 mg and succinylcholine 80 mg and is ventilated with 0.75% isoflurane in oxygen. Arterial pressure decreases abruptly from 140/100 to 80/50 mmHg while heart rate remains unchanged at 70 bpm. Failure of heart rate to increase most likely results from
(A) acute hypoglycemia
(B) autonomic neuropathy
(C) depression of sinus node function by thiopental
(D) depression of the baroreflex response by isoflurane
A patient whose trachea is intubated develops partial airway obstruction two hours after induction of fentanyl, nitrous oxide, oxygen anesthesia. The anesthesiologist discontinues the nitrous oxide and controls ventilation, and there is gradual improvement during the next hour. No evidence of a respiratory disorder is found at the conclusion of the anesthetic. Which of the following is most likely?
(A) The endotracheal tube was in the right mainstem bronchus
(B) The patient had an unrecognized air embolism
(C) The patient had a nitrous oxide pneumothorax
(D) The endotracheal tube cuff narrowed the airway