Adult Critical Care Specialty (ACCS) Practice Exam

A 18 y.o. male with a fractured femur develops confusion and dyspnea 36 hours later. What immediate intervention is advised?

1. Fluid restriction

2. Inhaled flolan

3. Heparin therapy

4. Low tidal volume ventilation

The correct answer is: Inhaled flolan

The scenario describes an 18-year-old male with a fractured femur who develops confusion and dyspnea 36 hours post-injury, which raises concerns about potential fat embolism, a well-known complication of long bone fractures. In cases of fat embolism syndrome, patients can experience respiratory distress and neurological symptoms, typically manifesting within 1 to 3 days after the injury. Inhaled Flolan, which is a prostacyclin (i.e., a vasodilator), helps improve oxygenation by dilating the pulmonary vasculature, thereby reducing the pulmonary artery pressure and improving blood flow in the lungs. It can be particularly beneficial for patients experiencing respiratory distress due to increased pulmonary vascular resistance or inflammation, which can occur with fat embolism. The use of inhaled Flolan in this scenario aims to address the immediate respiratory compromise and facilitate better oxygen delivery to the tissues. By improving ventilation-perfusion matching in the lungs, it can help mitigate the hypoxic effects associated with fat globules obstructing pulmonary capillaries. Thus, the choice of inhaled Flolan as the immediate intervention is justified given its role in managing the respiratory symptoms linked with potential fat embolism, ultimately improving patient outcomes in this acute setting.