An 88-year-old male with a 55 pack-year smoking history and an additional past medical history of COPD, and stage IA non–small cell lung cancer was referred for bronchoscopy. Prior to the procedure the patient was alert and oriented, afebrile, with BP 130/70, RR 14, and O2 saturation of 99% while breathing room air. The patient received a total of 100 µg IV fentanyl and 4 mg IV midazolam in divided doses during the bronchoscopy. Following the airway survey the diagnostic bronchoscope was removed and the patient received an additional 100 µg of fentanyl and 1 mg of midazolam prior to insertion of the scope for endobronchial ultrasound. Two minutes after insertion of the endobronchial ultrasound bronchoscope the patient developed a clenched hand and jaw and hypertension to 225/135 mm Hg. Respiratory motion was no longer evident upon examination of his chest wall. Oxygen saturation dropped to 81%. In addition to securing the airway the next most appropriate step would be:
A. Rapidly obtain CT of the head Wrong Choice!
B. Administer antihypertensives with a goal of lowering SBP 10% to 20% over an hour Wrong Choice!
C. Administer naloxone 0.2 mg IV Correct Choice
D. Administer 2 mg benztropine Wrong Choice!
Answer:C
An 88-year-old male with a 55 pack-year smoking history and an additional past medical history of COPD, and stage IA non–small cell lung cancer was referred for bronchoscopy. Prior to the procedure the patient was alert and oriented, afebrile, with BP 130/70, RR 14, and O2 saturation of 99% while breathing room air. The patient received a total of 100 µg IV fentanyl and 4 mg IV midazolam in divided doses during the bronchoscopy. Following the airway survey the diagnostic bronchoscope was removed and the patient received an additional 100 µg of fentanyl and 1 mg of midazolam prior to insertion of the scope for endobronchial ultrasound. Two minutes after insertion of the endobronchial ultrasound bronchoscope the patient developed a clenched hand and jaw and hypertension to 225/135 mm Hg. Respiratory motion was no longer evident upon examination of his chest wall. Oxygen saturation dropped to 81%. In addition to securing the airway the next most appropriate step would be:
A. Rapidly obtain CT of the head Wrong Choice! B. Administer antihypertensives with a goal of lowering SBP 10% to 20% over an hour Wrong Choice! C. Administer naloxone 0.2 mg IV Correct Choice D. Administer 2 mg benztropine Wrong Choice!