A 2-year-old girl is playing in the garage, only partially supervised by her father, who is weed-whacking around the garden gnomes in the front yard. He finds her in the garage, gagging and vomiting. She smells of gasoline. In a few minutes she stops vomiting, but later that day she develops cough, tachypnea, and subcostal retractions. She is brought to your emergency center. Which of the following is the most appropriate first step in management?
a. Administer charcoal
b. Begin nasogastric lavage
c. Administer ipecac
d. Perform pulse oximetry and arterial blood gas
e. Administer gasoline binding agent intravenously
the answer is below…
The United States Medical Licensing Examination, or USMLE for short, is a three-part licensing examination that is required in order to receive a license to practice medicine within the United States.
The USMLE assesses a physician’s ability to apply knowledge, concepts, and principles, and to determine fundamental patient-centered skills that are important in health and disease and that constitute the basis of safe and effective patient care.Examination committees composed of medical educators and clinicians from across the United States and its territories prepare the examination materials each year.
This exam is designed by the Federation of State Medical Boards and the National Board of Medical Examiners to determine whether or not an individual understands and can apply the knowledge necessary to practice medicine safely and intelligently.
The USMLE is actually comprised of three different exams that are referred to as steps, which examine the individual’s knowledge of specific topics related to the field of medicine such as basic science, medical knowledge, medical skills, clinical science, and the application of all of these skills and areas of knowledge in the medical field.
All three steps of the USMLE include a series of computerized multiple-choice questions, but the format of the exam and the information covered in each multiple-choice section is different for each step of the USMLE. The USMLE Step II also has a clinical skills portion that examines an individual’s ability to work with real patients and the USMLE Step III has a computerized patient simulation portion in addition to the multiple-choice section of the exam. In order for an individual to receive a license to practice medicine, the individual must pass all three steps of the USMLE.
The correct answer is d; Perform pulse oximetry and arterial blood gas.
Hydrocarbons with low viscosity and high volatility are the most likely agents to cause respiratory symptoms. Gasoline, kerosene, and furniture polish (which contain hydrocarbons) are common agents responsible for hydrocarbon aspiration. Hydrocarbon aspiration can produce dyspnea, cyanosis, and respiratory failure. Treatment is symptomatic, sometimes requiring intubation and mechanical ventilation. Induction of emesis is contraindicated, as this may cause further aspiration. Placement of a nasogastric tube is used only in high-volume ingestions or when the hydrocarbon is mixed with another toxin. Charcoal is not useful, and no intravenous binding agent is available.