Correct!
3. Insert bilateral chest tubes

The chest x-ray shows bilateral pneumothoracies right greater than left. After insertion of bilateral thoracostomy tubes her SpO2 improved to over 95% on a FiO2 of 100%. However, also note that the lungs do not appear normal. There appears to be diffuse consolidation. Corticosteroids do not prevent development of aspiration pneumonia. Bronchoscopy with bronchoalveolar lavage can be done to remove any large airway food particles, but unless clinically suspected to result in tracheal or major lobar obstruction, would have little role in this acute situation.

The patient's initial laboratory returned and is below:

• White Blood Cell Count: 9.3 X 103 cells/mcL
• Hemoglobin: 9.3 g/dL
• Hematocrit: 26.3%
• Na+: 151 mEq/L
• K+: 3.5 mEq/L
• Cl-: 120 mEq/L
• HCO3-: 8 mEq/L
• Arterial blood gases (ABGs): pO2 75, pCO2 41, pH 7.36 on an FiO2 of 100%, positive end expiratory pressure (PEEP) 20 cm H2O

Which of the following should be done next? (Click on the correct answer to proceed to the fourth of six panels)

1. Begin proning
2. CT scan of the chest, abdomen, and pelvis with contrast
3. Extracorporeal membrane oxygenation (ECMO)
4. 1 and 3
5. All of the above

Home/Critical Care