Rosh Emergency Medicine Practice Test

What is the initial management for a patient presenting with worsening productive cough and an SpO2 of 87%?

1. Administration of ceftriaxone and azithromycin

2. Endotracheal intubation

3. CIV methylprednisolone

4. Short-acting beta-agonist and supplemental oxygen to SpO2 88-92%

The correct answer is: Short-acting beta-agonist and supplemental oxygen to SpO2 88-92%

In the scenario presented, the patient exhibits a worsening productive cough along with low oxygen saturation (SpO2 of 87%). The initial management strategy aims to ensure adequate oxygenation and address any obstructive airway component that may be contributing to respiratory distress, which is particularly important in emergencies. Administering supplemental oxygen is crucial for patients with low SpO2 levels to improve their oxygenation status. Since the patient's SpO2 is notably low, providing supplemental oxygen will help bring the levels up to a safer range, typically a target of 88-92% for patients with chronic respiratory conditions or acute exacerbations. In addition, the use of a short-acting beta-agonist (SABA) can be beneficial, particularly if there is bronchospasm involved. SABAs can help relieve bronchoconstriction, improve airflow, and subsequently alleviate symptoms associated with respiratory distress and cough, especially in conditions like asthma or COPD exacerbations. The combined approach of oxygen supplementation and the short-acting beta-agonist addresses both the immediate need for oxygen as well as the potential bronchospasm, making it a comprehensive initial management strategy for this patient's condition.