A 50-year-old woman with subarachnoid hemorrhage and left hemiparesis undergoes clipping of a right cerebral aneurysm. On the second postoperative day, mental status deteriorates. Blood pressure is 110/70 mmHg. A cerebral angiogram shows vasospasm. The most appropriate management is to
(A) administer dexamethasone
(B) administer mannitol
(C) administer phentolamine
(D) expand intravascular volume
(E) intubate and hyperventilate to a PaC02 of 28 mmHg
D
A 54-year-old man is scheduled for open reduction of a fracture sustained when he jumped from a burning building. The carboxyhemoglobin concentration is 25%. Which of the following is the most reliable indicator of adequate oxygenation during general anesthesia?
(A) PaO2 of 300 mmHg
(B) pH of 7.38 with a PaCO2 of 41 mmHg
(C) Mixed venous PO2 of 45 mmHg
(D) Oxyhemoglobin saturation of 100% measured by co-oximeter
Addition of 20 cmH2O positive end-expiratory pressure to a patient receiving controlled mechanical ventilation decreases cardiac output and left ventricular function by
During pulmonary artery catheterization, a 65-year-old man receives morphine 6 mg and scopolamine 0.4 mg intravenously. The pulse oximeter indicates desaturation, which quickly resolves with stimulation. When the drapes are removed, he has unilateral eye pain, decreased visual acuity, and dilated and irregular pupils. These eye symptoms are most likely caused by
A pulmonary artery catheter is placed in an awake patient breathing room air. Typical right ventricular and pulmonary artery pressure tracings are obtained. With the catheter balloon inflated, blood drawn from the distal port has a PaO2 of 100 mmHg, while a simultaneous radial artery sample has a PaO2 of 90 mmHg. These data indicate that the
A previously healthy 26-year-old man sustains massive soft tissue injury in a motor vehicle accident. He appears to be well for 48 hours after initial resuscitation, then develops marked tachypnea. Arterial blood gas analysis would be most likely to show which of the following values? (pH, PaCO2, PaO2, FiO2)
(A) 7.53 60 75 .21
(B) 7.12 25 110 .30
(C) 7.09 60 90 .40
(D) 7.53 25 55 .80
(E) 7.28 40 195 .80
D
Which of the following findings is most likely in patients receiving intravenous milrinone?
A 58-year-old woman with rheumatoid arthritis and hyperactive gag reflex requires awake intubation prior to cervical spine stabilization. Which of the following regional nerve blocks is most appropriate?