The patient's ECG shows sinus rhythm with no acute ST-segment or T-wave changes. Supplemental oxygen by nasal canula is started. Which of the following would have been most effective in preventing this patient's current condition?

Question

The patient's ECG shows sinus rhythm with no acute ST-segment or T-wave changes.  Supplemental oxygen by nasal canula is started.  Which of the following would have been most effective in preventing this patient's current condition?

Quizplus · Accepted Answer

11ec25c8_d93c_0958_bc81_7d375da2eed4_MD0003_00 This patient developed postoperative atelectasis likely from a combination of retained airway secretions and postoperative abdominal pain. He likely would have benefitted from postoperative deep-breathing exercises and incentive spirometry, which encourage high-tidal-volume respiration and help keep alveoli open. In patients with underlying lung disease (eg, chronic obstructive pulmonary disease [COPD]), these interventions are often pursued preoperatively as well. Adequate postoperative pain control is also beneficial to minimize pain-induced restriction of chest expansion during respiration. Once atelectasis develops, it can be treated with continuous positive airway pressure (CPAP) to help open collapsed alveoli. Patients with abundant secretions may benefit from the addition of chest physiotherapy and suctioning. In some cases, atelectasis due to large mucus plugging may require mucus plug removal via bronchoscopy. (Choice A) Perioperative broad-spectrum antibiotics are not useful for the prevention of pneumonia, atelectasis, or other perioperative pulmonary complications, even in patients with asthma or COPD. Antibiotics should be used only if there is clear evidence of infection prior to urgent or emergency surgery. Elective procedures should be postponed until the infection has been adequately treated. (Choice C) Prophylactic-dose, low-molecular-weight heparin (eg, enoxaparin) lowers the risk of postoperative deep venous thrombosis and pulmonary embolism. (Choice D) Preoperative systemic glucocorticoids and albuterol have not been shown to prevent surgical complications, even in patients with asthma or COPD. Patients with poorly controlled asthma or COPD should be symptomatically optimized prior to elective surgery. (Choice E) Cigarette smoking is associated with an increased risk of perioperative pulmonary complications. Smoking cessation has been shown to reduce the risk of both pulmonary and overall surgical complications. However, the benefit is present only when cessation occurs >4-8 weeks prior to surgery, perhaps because the airway inflammation and increased mucus production caused by smoking require several weeks to improve. Educational objective: Deep-breathing exercises and incentive spirometry can help prevent postoperative atelectasis. Adequate postoperative pain control can also help by minimizing pain-induced restriction of chest expansion during respiration. References: Prevention of respiratory complications after abdominal surgery: a randomised clinical trial. (http://www.ncbi.nlm.nih.gov/pubmed/8563533) Preoperative physical therapy for elective cardiac surgery patients. (http://www.ncbi.nlm.nih.gov/pubmed/23152283)

The Patient's ECG Shows Sinus Rhythm with No Acute ST-Segment