You receive a new patient who received severe trauma to the front of her face from a suspected spousal abuse assault. You notice both blood and a clear fluid draining from the patient's nose.
What is your best treatment to prevent further injury to your patient?

Choice A rationale

Obtaining informed consent is a fundamental ethical and legal requirement before any invasive medical procedure, including a bronchoscopy. This ensures patient autonomy, allowing them to make an educated decision based on understanding the procedure's risks, benefits, and alternatives. The patient's signature indicates their voluntary agreement after a thorough discussion with the healthcare provider, demonstrating adherence to patient rights.

Choice B rationale

Flumazenil is a benzodiazepine receptor antagonist used to reverse the sedative effects of benzodiazepines. While benzodiazepines like midazolam are commonly used for conscious sedation during bronchoscopy, flumazenil is generally not kept readily available for routine use. It is an emergency reversal agent reserved for severe respiratory depression or over-sedation.

Choice C rationale

Ensuring the client is NPO (nil per os) for at least 6 hours prior to a bronchoscopy is crucial to prevent aspiration. The procedure involves manipulating the airway, which can stimulate the gag reflex and potentially lead to regurgitation of gastric contents into the lungs, causing aspiration pneumonia or acute respiratory distress. Fasting significantly reduces this risk.

Choice D rationale

Continuous monitoring of heart rate and oxygen saturation via a bedside heart monitor and pulse oximeter is essential during and after a bronchoscopy. This allows for immediate detection of adverse events such as hypoxemia, arrhythmias, or respiratory depression, enabling prompt intervention. Constant vigilance ensures patient safety throughout the procedure.

Choice E rationale

Midazolam, a short-acting benzodiazepine, is commonly used for conscious sedation during bronchoscopy. Its anxiolytic, sedative, and amnestic properties help to reduce patient anxiety, promote comfort, and minimize recall of the procedure. Its rapid onset and short duration of action make it suitable for outpatient procedures.

Choice A rationale

Dexamethasone is a corticosteroid, primarily used for its anti-inflammatory and immunosuppressive effects. While it may be used in certain respiratory conditions, it is not routinely co-administered with vecuronium to mitigate direct effects of neuromuscular blockade. Its use would be based on the underlying disease process rather than as an adjunct to neuromuscular blockade.

Choice B rationale

Fentanyl is a potent opioid analgesic. It is essential to administer an opioid like fentanyl concurrently with vecuronium because neuromuscular blocking agents induce paralysis without affecting consciousness or pain perception. Paralyzing a patient without providing adequate analgesia would be profoundly distressing and unethical, leading to severe anxiety and suffering.

Choice C rationale

Midazolam is a benzodiazepine, primarily used for sedation and anxiolysis. It is crucial to administer a sedative like midazolam concurrently with vecuronium because patients who are paralyzed by neuromuscular blockers are still fully conscious and aware of their surroundings. Sedation prevents psychological distress and ensures patient comfort during mechanical ventilation.

Choice D rationale

Furosemide is a loop diuretic, used to promote diuresis and reduce fluid overload. While fluid management is often critical in critically ill patients, especially those with ARDS, furosemide is not a medication that is routinely administered *with* vecuronium as a direct adjunct to its action. Its use would depend on the patient's fluid status and renal function.

Choice E rationale

Famotidine is a histamine H2 receptor antagonist, primarily used to reduce gastric acid production and prevent stress ulcers. While stress ulcer prophylaxis is common in critically ill patients, famotidine is not administered concurrently with vecuronium to mitigate direct effects of neuromuscular blockade. Its use is prophylactic and unrelated to the paralytic's action.