Step 2

Pulmonary 7

A 61-year-old woman with mild persistent asthma controlled with inhaled corticosteroids and an as needed albuterol inhaler presents to the emergency department with shortness of breath and audible “wheezing” for approximately 5-7 days after a total thyroidectomy for papillary carcinoma of the thyroid. The difficulty with breathing has steadily worsened, despite increasing use of albuterol. She reports a tingling sensation around the mouth and numbness in her hands and feet with sporadic muscle cramps mainly in the legs throughout the day and especially at night. On physical examination, she appears to be in mild respiratory distress, with a respiratory rate of 22 breaths/min, using some accessory muscles, and not being able to finish all her sentences. Lung examination is significant for expiratory wheezing throughout all fields. A chest radiograph is performed (see figure below). An arterial blood gas is drawn and shows a pH of 7.36, PCO2 of 40 mm Hg, and PO2 of 90 mm Hg on 2 L nasal cannula oxygen. The patient is given intravenous glucocorticoids and continuously nebulized albuterol and ipratropium. Despite this, she remains symptomatic with audible stridor.

Which of the following is the most appropriate next step in the treatment for this patient’s respiratory symptoms?

  • A) Calcium chloride or calcium gluconate intravenously
  • B) Double the dose of the intravenous glucocorticoids
  • C) Emergent intubation
  • D) Start intravenous aminophylline
  • E) Start intravenous terbutaline


Dr. Raj Dasgupta


Dr. Raj Dasgupta