After his endotracheal tube has been removed, a patient develops breathing difficulties. He has wheezes upon auscultation and exhibits intercostal retractions with each breath. The nurse suspects post-extubation swelling in the airway. Which medication would most likely be administered to correct this situation?

 

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Correct

- Nebulized epinephrine

- Albuterol

- Cromolyn sodium

- Acetylcysteine

Rationale

"Nebulized epinephrine" is correct. Nebulized epinephrine is an inhaled solution that relieves shortness of breath and wheezing. It can be used for the treatment of post-extubation swelling and breathing difficulties in a patient who was recently extubated and who is showing signs of respiratory distress. Nebulized epinephrine is inhaled through an atomizer and facilitates easier breathing by widening the size of the airway passages.

"Albuterol" is incorrect because albuterol does not act as quickly to reduce inflammation. Albuterol works to relieve wheezing and shortness of breath associated with many lung conditions, but in the case of post-extubation laryngeal edema as described in this question, nebulized epinephrine is the drug of choice.
"Cromolyn sodium" is incorrect because, although this drug reduces inflammation by preventing the release of histamines in the body, it is not used to quickly relieve airway inflammation in extubation.
"Acetylcysteine" is incorrect because this is a drug used for expectorating thick mucus associated with COPD and cystic fibrosis, not post-extubation laryngeal edema.

References:
Pluijms, W. A., Mook, W. N., Wittekamp, B. H., & Bergmans, D. C. (2015, September 23). Postextubation laryngeal edema and stridor resulting in respiratory failure in critically ill adult patients: Updated review. Retrieved May 29, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4580147/
Mull, C. C., Scarfone, R. J., Ferri, L. R., Carlin, T., Salvaggio, C., Bechtel, K. A., . . . Gracely, E. J. (2004, February). A randomized trial of nebulized epinephrine vs albuterol in the emergency department treatment of bronchiolitis. Retrieved May 29, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/14757602

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Question ID - 16195

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