ACCS Question of the Week - Answer

*Answer = A* 

(C) A. As you scan through questions with more content, it is important to pull out what's relevant. In this case we have a patient who has a poor GCS (remember, very generally, under 8 ... intubate!); a fever (infection? sepsis?) ; hypotension (hypotension + fever = septic shock??). The only option that addresses the issues closely is A, intubate and give a pressor. Also - another interesting indicator here is that the HR is not high (compensated shock = the body's ability to maintain adequate O2 delivery by increasing CO). This may suggest uncompensated shock ... a patient rapidly deteriorating. 

(H) B. While oxygen won't harm the patient at 93%, the really is no ACCS clinical need for it. Observing is an inadequate response to what is presented. 

(H) C. Labetalol is a beta blocker. It will likely decrease blood pressure, the opposite of the goal here. Because of GCS and hemodynamic instability NPPV would not be indicated. 

(U) D. Oxygen is not clinically indicated at this point. It won't hurt, but it won't do anything to address what is presented - see A. tPA is indicated in a confirmed pulmonary embolus with hemodynamic compromise. The question would need to state somewhere that the patient has a PE (usually via a CT scan).

Key Used: 

(C) is the correct answer 
(A) is an alternate answer (good choice but not best choice)
(U) is an unacceptable answer (so wrong choice)
(H) is an answer that potentially brings harm to the patient (there's no greater penalty for this)