The respiratory therapist is assessing a mechanically ventilated patient for whom the high pressure alarm is active and the flow-volume loop shows the following:
The action that could alleviate this problem is which of the following?
a. Place a bite block into the patient's mouth.
b. Perform a recruitment maneuver and in-crease PEEP.
c. Administer a fast-acting bronchodilator and suction the ET tube.
d. Insert a 14-gauge needle into the second intercostal space, midclavicular line, and right side.
ANS: C
The flow-volume loop shows increased expiratory resistance; this plus activation of the high pressure alarm indicates increased airway resistance. Increased airway resistance can be caused by bronchospasm, which can be alleviated by a bronchodilator and suctioning. Although a patient biting the tubing would cause a high pressure alarm, no or very little volume would enter the pa-tient, and the flow-volume loop would not be as large. The flow-volume loop is not indicative of low compliance, which would necessitate a recruitment maneuver and increased PEEP. The ex-piratory flow would not be "scooped out" if low compliance were a problem. Because the signs indicate increased airway resistance, needle decompression is not appropriate.
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