A pt is started on a spontaneous breathing trial, which he i

Discussion in 'USMLE Step 2 CK' started by Guest, Jan 7, 2011.

  1. Guest

    Guest Guest

    A 68-year-old man with chronic obstructive pulmonary disease, hypertension, and hyperlipidemia is being weaned from mechanical ventilation. The patient's current medications are ipratropium and albuterol both by metered dose inhaler through the ventilator circuit; prednisone, 40 mg/d; lisinopril, 5 mg/d; and atorvastatin, 10 mg/d.

    He is started on a spontaneous breathing trial, which he initially tolerates well, but later shows evidence of oxygen desaturation and agitation. He is given increasing doses of lorazepam to cause sedation, and assist control ventilation is resumed. The following day he is calm but confused.

    Which of the following instruments is most likely to be of value in evaluating the patient?

    A Beck's depression scale
    B Determination of activities of daily living (ADLs)
    C Confusion assessment method for the intensive care unit (CAM-ICU)
    D Mini-mental state examination
    E Determination of instrumental activities of daily living (IADLs)
  2. Guest

    Guest Guest

    Answer = C
    Key Point
    The CAM-ICU, a clinical instrument for use in evaluating a patient in the intensive care unit for delirium, takes less than a minute and is recommended for all mechanically ventilated patients.

    The CAM-ICU is a clinical instrument for nurses and doctors to use in evaluating a patient for delirium; the assessment takes less than a minute and is recommended for routine monitoring of all mechanically ventilated patients. The CAM-ICU, a well-validated and highly reliable method now translated into more than ten languages, is widely used around the world for monitoring delirium in ICU patients. The other instruments all monitor other aspects of patients' mental or functional status, but are not appropriate at this time and in the face of supposed confusion.

    The prevalence of delirium in most studies of mechanically ventilated patients is between 50% and 80%. ICU delirium has been shown to be an independent predictor of ICU and hospital length of stay, cost of care, cognitive status at hospital discharge, and 6-month mortality. The agitated, hyperactive motoric subtype of delirium is much less common than the “quiet” hypoactive subtype, which is generally associated with, though not necessarily causal of, a lower likelihood of survival.

Share This Page