A 28-year-old man with botulism poisoning is beginning to develop progressive paralysis. The respiratory therapist has been monitoring the patient's MIP and VC every 2 hours
The most recent results show that the patient continues to deteriorate: MIP = ?27 cm H2O, VC = 32 mL/kg. Which of the following could be appropriately recommended?
a. Gastric lavage
b. Oxygen therapy
c. Medication to reverse the paralysis
d. Mechanical ventilatory support
ANS: D
The critical values for the parameters listed are: maximum inspiratory pressure (MIP) −20 to 0; vital capacity (VC) <10-15 mL/kg ideal body weight (IBW); alveolar to arterial partial pressure [P(A-a)O2 ] >450 on O2; and maximum expiratory pressure (MEP) <40 cm H2O. This patient's con-dition is worsening and requires mechanical ventilatory support.
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