Pulmonary

Question 1

Risk after drowning resuscitation

Answer 1

Acute respiratory distress syndrome; observe for 8 hours, then X-ray

Tissue injury –> inflammation
Washout of alveolar surfactant –> atelectasis
Disruption of osmotic gradient of alveolar-capillary membrane –> increased fluid permeability

Question 2

Two types of decompression sickness

Answer 2

Type 1 (mild) - MSK (bends - painful joints), cutaneous (pruritus, erythema), lymphatic (localized edema)

Type 2 (severe) - neurologic (staggers - ataxia, dizziness, possibly spinal cord involvement, others), pulmonary (chokes - obstructive shock)

Question 3

Capnography pattern with bronchospasm (wheezing)

Answer 3

Shark fin pattern with changes to normal alpha angle and phase 2 of waveform (anatomical alveolar dead space), along with progressive elevation of baseline ETCO2

Question 4

Order of evaluation of massive hemoptysis (>600 mL/day or >100 mL/hr)

Answer 4

Secure airway, then bronchoscopy, then PA, then urgent thoracotomy and surgery