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Acute respiratory distress syndrome — RCPSC EM MCQ

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HardRespiratory emergenciesAcute respiratory distress syndromeRCPSC EM

A 46-year-old with severe pancreatitis is intubated for hypoxaemia. Chest radiograph shows bilateral infiltrates, echocardiogram shows normal left ventricular function, and PaO2/FiO2 ratio is 95 on PEEP 10 cm H2O. Plateau pressure is 34 cm H2O. What is the most appropriate initial management?

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Correct answer: E — Use lung-protective ventilation with lower tidal volume and limit plateau pressure

Use lung-protective ventilation with lower tidal volume and limit plateau pressure is correct: the clues indicate Acute respiratory distress syndrome and this option addresses the immediate ED priority. The distractors delay care, target a less likely problem, or are unsafe in this physiology.

Reference: Critical care ventilation practice; Canadian ED ICU transition