Answer: Thiosulfate (B)
References: Curry, SC (2005) Sodium nitroprusside. In: Brent J, Wallace K, Burkhart K et al. (2005) Critical Care Toxicology, Mosby Philadelphia, PA. Schulz V, Gross R, Pasch T, et al. (1982) Cyanide toxicity of sodium nitroprusside in therapeutic use with and without sodium thiosulfate. Klinische Wochenschrift 60, 1393–400. Varon J, Marik PE (2000) The diagnosis and management of hypertensive crises. Chest 118, 214–27.
Furosemide 40mg IVP and KVO IVF
100% oxygen via non-rebreather mask
BiPAP at 15/7cm H2O and FIO2 100%
Intubation and mechanical ventilation (D)
Answer: Intubation and mechanical ventilation (correct)
Explanation: An ECG trace with tachycardia demonstrating p waves of three different morphologies is termed multifocal atrial tachycardia (MAT). MAT is unique among atrial dysrhythmias in that is it strongly associated with impending acute respiratory failure and as such represents a stress rhythm. Therapy hinges on addressing the patient’s elevated work of breathing by providing immediate endotracheal intubation and mechanical ventilation. None of the other therapies provides deﬁnitive management and do not address the underlying cause of MAT. BiPAP does provide some ventilatory support but is in general inadequate at relieving the patient of all of the work of breathing.References: Biggs FD, Lefrak SS, Kleiger RE, et al. (1977) Disturbances of rhythm in chronic lung disease. Heart and Lung 6 (2), 256–61.
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