Tingnan ang lahat ng mga set ng pag-aaral

Airway, ABG, and Flight

Pataasin ang iyong marka sa homework at exams ngayon gamit ang Quizwiz!

A. 67.5 mEq/L B. 70.5 mEq/L C. 337.5 mEq/L D. 160 mEq/L

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On arrival of a 12 y/o F who has ingested a large number of their grandparent's tums your partner states that they are concerned with the patient having a Left shift on the oxyhemoglobin dissociation curve. Of the following choices which are not a cause of a left shift on the oxyhemoglobin dissociation curve? A. A decreased affinity of O2 to Hemoglobin B. Hypothermia C. Respiratory Alkalosis D. Decreased levels of 2-3 DPG

???? not hypothermia

What is a normal I:E (inspiratory/expiratory) ratio? A. 1:2 B. 1:3 C. 1:4 D. 1:1 E. 1:1.5

A. 1:2 The ratio of inspiration vs. expiration (it takes longer to breath out) In normal physiology of breathing, it takes twice as long to exhale as it does to inhale. Making a normal Inspiratory to expiratory ratio 1:2.

You are on the scene of a patient who you decided to intubate and RSI due to hypoxia and the need for airway protection. You are unsuccessful with the first intubation attempt. How many more attempts at intubation can be made? A. 2 B. 1 C. 3 D. 4 E. 0

A. 2 There should be a TOTAL of 3 attempts at intubation. With one attempt already made, there are only 2 more attempts at intubation before moving to the next step of the failed airway algorithm.

What is the target range for ETT cuff pressure? A. 20-30 mmHg B. 10-15 mmHg C. 5-10 mmHg D. 30-40 mmHg

A. 20-30 mmHg The target endotracheal tube cuff pressure should be 20-30 mmHg. This is to help prevent excessive inflation of the ETT cuff. This can cause laryngeal trauma.

What is considered a normal Vt (tidal volume)? A. 4-8 ml/kg/IBW B. 6-10 ml/kg/IBW C. 2-4 ml/kg/IBW D. 8-10 ml/kg/IBW E. None of the above

A. 4-8 ml/kg/IBW Tidal volume (Vt) is the amount of gas delivered with each breath from the ventilator. A normal tidal volume is 4-8 ml / kg of IBW (ideal body weight).

A pulse oximetry of 90 % correlates with which approximate PaO2 level of oxygenation? A. 60 mmHg B. 50 mmHg C. 80 mmHg D. 70 mmHg

A. 60 mmHg A pulse oximetry of 90 % correlates with a PaO2 level of approximately 60 mmHg.

You respond to a call in a long term care facility for an elderly patient with the following ABG values: pH 7.25; PaCO2 42 mmHg; HCO3- 19 mEq/L PaO2 of 65 mmHg. As you interpret the blood gas you turn to your partner to let them know the patient is hypoxic based on the Pao2 and not able to oxygenate.A normal Pa02 should be between and mmHg. A. 80 & 100 B. 60 & 80 C. 70 & 100 D. 80 & 110

A. 80 & 100

You are on the scene of a major trauma with severe multi-system injuries. The patient has the following vital signs: BP: 70/P HR: 140 SPo2: 74% RR: 40. The patient now is breathing irregularly and unable to control his airway requiring RSI procedure. What is the most correct treatment for the patient initially? A. Administer a fluid bolus B. Administer Fentanyl C. Administer Ketamine D. Administer Anectine

A. Administer a fluid bolus Initial treatment of the patient is a bolus of IV fluids. WIthout administering IV fluid to increase BP, it is likely the patient's BP will decrease during the RSI procedure. This in combination with introducing positive pressure ventilation can cause post-RSI cardiac arrest.

The value Pplat is a direct reflection of what? A. Alveolar compliance B. Pressure in the upper airways C. Acidosis D. VTE E. None of the above

A. Alveolar compliance Pplat is a reflection of lower airway pressures and static lung compliance (Alveolar Compliance). This is done with an inspiratory hold maneuver on the ventilator allowing gas to equalize within the alveoli and the lower airways. This is a reflection of alveolar compliance and lower airway pressures.

This is characterized as an abnormal pattern of breathing characterized by deep, gasping inspiration with a pause at full inspiration followed by a brief, insufficient release. A. Apneustic B. Biots C. Cheyne-Stokes D. Ataxic E. Kussmauls

A. Apneustic An Apneustic breathing pattern is characterized as an abnormal pattern of breathing characterized by deep, gasping inspiration with a pause at full inspiration followed by a brief, insufficient release. Associated with Decerebrate Posturing

Which mode of ventilation is associated with auto PEEP or breath stacking? A. Assist Control B. SIMV C. CMV D. PRVC E. APRV

A. Assist Control Assist Control is the mode associated with breath stacking due to the mode supplying the entire set tidal volume with every triggered and mandatory breath. This can cause high pressures within the thoracic cavity and breath stacking if PVD occurs leading to ventilator-induced lung injuries to occur.

Which of the following best describes Carbon Dioxide? A. CO2 is a normal byproduct of metabolism that is measured in partial pressures (PaCO2) B. CO2 is an indicator of base C. CO2 exists in the blood as a non-soluble gas D. CO2 is a normal byproduct of the break down of carbohydrates that is measured in partial pressures (PaCO2)

A. CO2 is a normal byproduct of metabolism that is measured in partial pressures (PaCO2)

Which of the following causes listed below would NOT create a high-pressure alarm A. Chest tube seal leak B. ARDS C. PVD D. Brochospasm E. All of the above

A. Chest tube seal leak Chest tube seal leak, dislodged ET Tube, disconnection from ventilator, circuit leak, airway leaks and hypovolemia are all causes of low pressure alarms

You are transporting a 12 y/o male post-fall with a visible right humeral fracture. Prior to leaving the sending facility, you are provided with the following ABG: pH 7.42; PaCO2 25 mmHg; HCO3- 20 mEq/L. Based on the following ABG, which of the following acid-base imbalances do you suspect? A. Compensated Respiratory Alkalosis B. Compensated Metabolic Acidosis C. Uncompensated Respiratory Alkalosis D. Mixed Gas Imbalance

A. Compensated Respiratory Alkalosis pH: Normal and fully compensated (7.42)CO2: low (alkalotic) below 35 mmHg, pH and CO2 are traveling opposite of each other making the respiratory system the offender.HCO3: low (acidic) below 22 mEq/L. This is compensating for respiratory alkalosis.Using 7.4 as a perfect pH, 7.42 is closer to the alkalotic range making this a fully compensated alkalosis. CO2 is low and also alkalotic. HCO3 is low (acidic). pH and CO2 are traveling opposite of each other making this a compensated respiratory alkalosis.

You have arrived on the scene of a 56 y/o M complaining of chest pain and difficulty breathing with copious amounts of frothy sputum coming out. Your cardiac 12-lead interpretation reveals an Anterior STEMI. Which of the following medications would be the drug of choice for induction in the RSI process? A. Etomidate B. Fentanyl C. Ketamine D. Midazolam

A. Etomidate Providers should avoid the use of Ketamine in patients who they suspect are in heart failure. The direct effect of ketamine on the heart is negatively inotropic, especially in heart failure. Etomidate or Versed would be a better choice for induction agents.

As you and your partner attempt to intubate a 13 y/o F who has fallen out of tree and has significant facial injuries you note that the patient becomes bradycardic and hypoxic as evidence by an pulse ox of 78% despite positioning, bag mask ventilation, and placement of a supraglottic airway. What type of situation does this represent? A. Failure to oxygenate and ventilate B. Failure to oxygenate and position C. Rapid Sequence Intubation D. Delayed Sequence Intubation

A. Failure to oxygenate and ventilate Anytime you are not able to ventilate or oxygenate your patient you should be thinking of performing a cricothyrotomy or needle cricothyrotomy. This is a scenario that the provider must be able to recognize quickly to mitigate the continued deterioration of the patient as further positioning and adjunct are most likely not to be successful.

Which of the following is considered to be the most recognizable and reversible causes of hypoventilation of a mechanically ventilated patient? A. Foreign body airway obstruction B. Tension Pneumothorax C. Pulmonary Embolism D. Sepsis

A. Foreign body airway obstruction The most common and recognizable cause of hypoventilation is considered to be a foreign body airway obstruction

Which of the following is not a contraindication for the administration of Succinylcholine? A. History of cancer B. Hyperkalemia C. Crush Injuries D. Burns >24 hours

A. History of cancer Succinylcholine Contraindications: Hyperkalemia Crush injuries Eye injuries Narrow angle glaucoma History of Malignant Hyperthermia Burns > 24 hrs. Any nervous system disorder: Guillain-Barre & Myasthenia gravis (discussed more in neuro)

You have been dispatched to transport a patient from a rural ICU facility. The patient report that you receive from the sending physician states that the patient was initially admitted for and NSTEMI but now has marked ST elevation in the Anterior Leads and has become increasingly difficult to ventilate and oxygenate with mechanical ventilation. Currently, the ventilator settings are:A/C-V Vt 380 ml (F) 20 Inspiratory time: 0.80 secs. FIO2 1.0 PEEP 10 cmH2O, Pplat 28 mmHg.The patient is currently laying supine with HOB at 30' and has the following ABGpH 7.25 PCO2 30mmHg HCO3 16 mEq/L PaO2 50mmHgGiven all of the information available, which of the following changes can you make on the ventilator to improve the PaO2? A. Increase I-Time B. Decrease PEEP C. Increase Vt D. Increase Rate

A. Increase I-Time Based on the above settings the patient with a hypoxic respiratory failure is in need of more I-Time to allow the diffusion of the oxygen across the alveolar membrane. This will lead to an inverse I:E ratio (2:1). Also, consider FiO2 to 1.0 if not already and additional PEEP after increasing I - time.

You have been dispatched to transport a patient diagnosed with CHF exacerbation who is currently intubated and being mechanically ventilated. The patient's current ventilator settings are: SIMV-Volume Vt 480 ml (f) 20 FIO2 1.0 I:time 0.8 PEEP 5 cmH20 The patient's current vital signs are: BP: 176/98 SPO2 87% CO2 45 mmHg HR: 99 What is the most appropriate intervention to perform for the patient? A. Increase PEEP B. Increase Vt C. Increase (f) D. Decrease inspiratory time E. Decrease Vt

A. Increase PEEP PEEP should be increased to increase oxygenation. An increased PEEP will help "drive" the oxygen molecule through the alveolar-capillary membrane under higher pressures. This will help to increase a high-pressure gradient to displace pulmonary edema so better oxygenation can take place. (same idea as CPAP in a 911 CHF setting)

You are called to transport a patient that is being mechanically ventilated. The patient is currently on the following ventilator settings: A/C-Volume Vt: 450 mL (f) 18 Inspiratory time: 0.8 sec. FIO2 1.0 PEEP 5 cmH2O While assessing the ventilator you note a Pplat of 20 and a PIP of 22. What is the next best course of action? A. Increase Vt B. Increase FIO2 C. Decrease (f) D. Increase expiratory time E. None of the above

A. Increase Vt A PIP of 22 and a Pplat of 20 suggests that more lung can be recruited with ventilation. Vt and F can both be increased to recruit more lung tissue and obtain a pPlat goal of approximately 25-27. Remember that the Pplat should NEVER exceed 30.

You are transporting a patient who was intubated for respiratory failure secondary to COPD exacerbation. The patient is being mechanically ventilated with the following ventilator settings: A/C Volume Vt: 550 mL (F) 20 Inspiratory time: 1.0sec I:E Ratio: 1:2 FIO2 1.0 PEEP 5 cmH20Pplat: 26 mmHg The patients current ABG is: pH: 7.18 PCO2: 72 mmHg HCO3 27 mEq/L PaO2 70 mmHg What is the most appropriate change to make to the ventilator settings to improve the patient's condition? A. Increase the expiratory time B. Increase the inspiratory time C. Increase Vt D. Increase (f) E. Increase PEEP

A. Increase the expiratory time A patient with a pulmonary obstructive disease process requires a longer time to exhale due to the auto peep that is created from the expiratory disease process. This patients Pplat tell us they have enough Vt and the rate is appropriate to the patient however their I:E ratio is 1:2 and we know that they are air trapping so we need to allow more time for exhalation of the CO2. We can do this by decreasing their I-time (< 1.0 Sec) or rate until we have an I:E ratio of 1:3-6. If there is not enough time to allow for exhalation, the patient will increase intrathoracic pressure and retain CO2 in the lungs. This can also cause barotrauma and hypotension due to a decrease in venous return to the heart.

You respond to a community hospital to transport a 78 y/o male complaining of respiratory failure with a history of COPD. Shortly after your arrival, the attending physician intubates the patient and asks you to assist the respiratory therapist with setting up the patient's ventilator for transport. Which of the following settings are most appropriate for this patient? A. Increased E-Time B. Low Vt C. High PEEP D. High f

A. Increased E-Time Management Allowing more time for exhalation Reduce the respiratory rate (RR) or I: E ratio (typically to 1:3-1:5) to allow more time for exhalation and reduce breath stacking. This may result in low minute ventilation causing hypercapnia, hypoxia or acidosis so watch your rate and ME (6-8L/min) Vt x Rate = ME

Cardiogenic pulmonary edema is caused by the failure of which of the following heart chambers? A. Left ventricle B. Right ventricle C. Left atrium D. Right atrium

A. Left ventricle Cardiogenic pulmonary edema is caused by the failure of the left ventricle to clear due to the myocardial ischemia occurring.

You have been called on the transport of a female patient who was recently intubated for respiratory failure and CHF exacerbation. Upon assessment, you are able to view the chest XR to confirm the correct placement of the ETT. Which of the following locations would indicate correct placement? A. Level of T2-T4 vertebrae B. Level of C-7-T1 vertebrae C. 2-3 inches above carina on chest X-Ray D. None of the Above

A. Level of T2-T4 vertebrae Correct endotracheal tube placement can be verified if it is noted to be at one of these 3 locations:Level of the T2-T4 vertebrae upon viewing chest X-Ray.,2-3 cm above the carina,1 inch above the carina.

When referring to the mnemonic LOAD what does the "L" in LOAD stand for? A. Lidocaine B. Laryngoscopy C. Look D. Labetalol E. None of the above

A. Lidocaine LOAD is a pneumonic for pre RSI medications. Lidocaine Opiates Atropine Defasciculation dose.

You have just completed an RSI procedure on a patient who was kicked by a horse and presented with unequal pupils, bradycardia, and hypertension. After administering Fentanyl, Ketamine, and Anectine, you perform laryngoscopy without incident and 5 mins after the procedure you notice a change in patient condition. Patient vitals reveal BP: 180/115 mmHg, RR 24, Spo2 92% with a rapidly rising ETCO2 currently at 60 mmHg. The patient has also increased their temperature and is having severe muscle spasms. Which of the following conditions is the patient suffering from? A. Malignant Hyperthermia B. Inadequate sedation C. Allergic reaction D. Hypoventilation E. None of the above

A. Malignant Hyperthermia Malignant Hyperthermia occurs after administration of Succinylcholine to a patient who is hypersensitive. This condition causes a rapidly increasing ETCO2 despite increasing ventilation rate, severe muscle spasms, and hyperthermia. The antidote for this condition is Dantrolene Sodium.

Which drugs block acetylcholine neurotransmitter action thus inducing flaccidity of muscles without depolarizing the synaptic membrane? A. Non- Depolarizing Paralytics B. Depolarizing Paralytics C. Benzodiazepines D. Sodium Channel Blockers

A. Non- Depolarizing Paralytics Non-depolarizing drugs interrupt transmission at the skeletal neuromuscular junction without causing depolarization of the motor end plate (synaptic membrane). They prevent acetylcholine from triggering muscle contraction.

You and your crew arrive on the scene of a 56 y/o M with a history of COPD who on assessment is in the tripod position who present with a "barrel chest" and pursed lips breathing. The patient's vital signs are: HR 114 B/P 102/62 RR 28 labored Spo2 98% EtCo2 NC 71 mmHg Based on the above assessment, which of the following ventilator settings is the patient's respiratory pattern mimicking? A. PEEP B. Pressure Support C. I - Time D. I- Hold

A. PEEP The patient's pursed lips breathing is mimicking the PEEP ventilator setting by creating internal airway stenting of the alveoli to remain open.

What are the two ways to improve SPO2 in patients that are being mechanically ventilated? A. PEEP and FIO2 B. Vt and (f) C. PEEP and (f) D. PS and PEEP E. None of the above

A. PEEP and FIO2 Two ways to improve oxygenation in a patient on a ventilator is increasing the fraction of inspired oxygen (increasing the amount of oxygen delivered) and increasing PEEP ( this allows for more alveoli to be recruited for gas exchange and also maintains the recruitment of alveoli so gas exchange can take place over more surface area of the lungs).

You and your crew arrive on the scene of 72 y/o F who is complaining of exacerbation of her CHF, who states she has not taken her "water pill" in 3 days and is having a difficult time breathing and exhibits signs of intercoastal retractions and tracheal tugging. Despite the on-scene crew's efforts to deliver O2 therapy and pharmacological interventions, the patient clinical signs are not improving, and her LOC is diminishing. Which of the following would be the next course of action based on the patient's condition above? A. Perform intubation and place the patient on a mechanical ventilator B. Place the patient on NPPV C. Administer a beta 2 agonist D. Administer a loop diuretic

A. Perform intubation and place the patient on a mechanical ventilator This patient is experiencing an exacerbation of CHF and has fluid and plasma filling the interstitial space, thus making it harder for oxygen to diffuse across the alveolar membrane. With the patient diminishing and losing her LOC, NPPV is no longer a choice. This patient requires intubation and mechanical ventilation. Her initial settings should be inline with a hypoxic respiratory patient.Increased FiO2, Increased PEEP, Increased I-Time, and a reversed I:E Ratio.

You are on scene with a pediatric status epilepticus patient who is non responsive and has trismus present. As you and your partner prepare for RSI you recall the 7p's. Which of the following is not one of the 7p's of performing an RSI? A. Planning B. Preparation C. Preoxygenate D. Pretreatment

A. Planning 7 P's of RSI are: Preparation Preoxygenate Pretreatment Paralysis with induction Protect and position Placement with proof Post intubation management

Which of the following best describes the the rapid coadministration of anesthetics and neuromuscular blockades? A. Rapid Sequence Induction B. HEAVEN C. Non-Invasive Positive Pressure Ventilation D. Delayed Sequence Intubation

A. Rapid Sequence Induction RSI involves co-administration of weight-based doses of an inductionagent (eg, ketamine, etomidate) immediately followed by a paralyticagent (eg, rocuronium, succinylcholine) to rapidly render the patientunconscious and paralyzed.

You and your partner have just completed an RSI of a 32 y/o F polytrauma patient post high speed MVA. As you are about to leave the scene you note a decreased ETCO2. Which of the following is not a cause of a decreased ETCO2? A. Respiratory Acidosis B. Poor Perfusion C. Pulmonary Embolism D. Obstruction

A. Respiratory Acidosis Low ETCO2 can indicate poor systemic perfusion, which can be caused by hypovolemia, sepsis or dysrhythmias. Cardiac arrest is the ultimate shock state; there is no circulation or metabolism and no CO2 production unless effective chest compressions are performed. Pulmonary embolism can also cause a low ETCO2.

You and your partner are preparing to intubate a patient who has copious amt of fluid and blood coming from the airway. Which of the following techniques would you want to consider? A. SALAD B. HEAVEN C. LOAD D. DOPE

A. SALAD SALAD is an acronym for the technique of Suction-Assisted Laryngoscopy and Airway Decontamination developed by Dr Jim DuCanto, who has created both a training model to give practitioners an opportunity to manage an airway during regurgitation of large volumes of blood or gastric contents, and also a dedicated large-bore suction rigid suction catheter for these instances.

Tall thin males, who have a history of smoking are more susceptible to which kind of pulmonary emergency? A. Spontaneous Tension Pneumothorax B. CHF C. ARDS D. Asthma

A. Spontaneous Tension Pneumothorax Spontaneous pneumothorax is the sudden onset of a collapsed lung without any apparent cause.Tall and thin adolescent males are typically at greatest risk, but females can also have this condition. A history of smoking will drastically increase chances.

You are on the scene of a medical patient who has been exposed to with organophosphates with copious amounts of secretions. The patient has the following vital signs: BP: 140/ 80 HR: 160 SPo2: 80% RR: 42 labored The patient now is breathing irregularly and unable to control his airway requiring RSI procedure. Which of the following paralytics should you avoid? A. Succinylcholine B. Etomidate C. Vecuronium D. Rocuronium

A. Succinylcholine When you have a patient that has been exposed to an organophosphate type poisoning, the clinician should anticipate a prolonged Succinylcholine-Induced paralysis in organophosphate poisoning and depending on the level of poisoning succinylcholine may be ineffective at paralysis. Rocuronium may be a better paralytic to initiate paralysis.

You have arrived at the scene of a facility where a patient has a rapidly decreasing level of consciousness. The patient is noted to have a sine wave present upon an assessment of a 12 lead ECG. Further assessment notes the patient has a dialysis shunt in his left arm. You have elected to intubate and RSI this patient due to respiratory failure and a rapidly declining level of consciousness. Which of the following would NOT be a drug of choice to use in the RSI process? A. Succinylcholine B. Pancuronium C. Rocuronium D. Ketamine

A. Succinylcholine A "sine wave" is a sign of severe hyperkalemia. Succinylcholine is contraindicated in the presence of hyperkalemia. This drug is contraindicated due to its mechanism of action. When Succinylcholine is administered, all of the acetylcholine receptor sites are flooded and depolarized all at the same time. This reaction of rapid depolarization causes a shift in serum Potassium of approximately 0.5 and can further worsen a hyperkalemic state.

You are transporting a patient that is being mechanically ventilated. The patient's ventilator settings are: Assist Control - Volume Vt: 400 mL (f) 18 Inspiratory time: 0.8 sec. FiO2 1.0 PEEP 5 cmH2O During transport, you notice the patient's BP has fallen to 80/40 mmHg. In addition, the patient's SpO2 has decreased to 88%. You note on the ventilator a high-pressure alarm with a PIP of 45 and a pPlat of 35. What is most likely the cause of the patient's condition? A. Tension Pneumothorax B. Kinked ET Tube C. Bronchospasm D. Myocardial infarction E. Cardiogenic shock

A. Tension Pneumothorax The PIP and pPlat are both elevated signaling a high pressure with a decreased lung compliance. Out of the list of answer choices, a pneumothorax is the only cause of an increase in lower airway pressures (decrease in lung compliance). The hypotension indicates that this pneumothorax is now a tension pneumothorax that is decreasing venous return to the right side of the heart.

Your crew is dispatched to transport a 38 y/o male suffering from DKA. T he patient reportedly has a BGL of 484 mmol/L and came in complaining of respiratory distress. After your arrival and assessment, the sending physician provides you with the following ABG: pH 7.10; PaCO2 40 mmHg; HCO3- 16 mEq/L. Based on these values, which type of acid-base imbalance is most likely? A. Uncompensated Metabolic Acidosis B. Uncompensated Metabolic Alkalosis C. Uncompensated Respiratory Alkalosis D. Compensated Metabolic Alkalosis

A. Uncompensated Metabolic Acidosis

Your crew is dispatched to transport a 2 y/o male to a pediatric facility. The patient reportedly ingested an unknown amount of Tums antacid. After your arrival and assessment, the sending physician provides you with the following ABG: pH 7.50; PaCO2 44 mmHg; HCO3- 33 mEq/L. Based on these values, which type of acid-base imbalance is most likely? A. Uncompensated Metabolic Alkalosis B. Uncompensated Metabolic Acidosis C. Uncompensated Respiratory Alkalosis D. Compensated Metabolic Alkalosis

A. Uncompensated Metabolic Alkalosis pH: high (alkalotic) and above 7.45 CO2: NORMAL within 35 to 45mmHg, not compensating HCO3: High (alkalotic) above 26 mEq/L so pH and HCO3 are traveling together making this a Metabolic Alkalosis. The CO2 is normal and not attempting to compensate. Therefore, this is an UNCOMPENSATED metabolic alkalosis.

When treating a patient suspected of having a pulmonary embolus you suspect the patient's hypoxemia is caused by which of the following mechanisms? A. V/Q Mismatch B. Loss of cardiac preload C. Increase in pulmonary vascular resistance D. Cardiogenic shock

A. V/Q Mismatch The main mechanisms of hypoxemia in PE ia a V/Q mismatch along with the low level of mixed venous blood oxygen (PvO2). V/Q mismatch occurs due to the redistribution of blood from occluded pulmonary arteries to the nonoccluded vessels.Patients suffering from a PE may also develop diffusion limitation due to a reduction in pulmonary blood flow by obstruction of the pulmonary vasculature and reduced COPatients with a Normal PaO2 and normal A-a oxygen gradient does not rule out acute PE.

Which test is most often used to diagnose the presence of a Pulmonary Embolism? A. V/Q scan B. chest XR C. MERCI D. Swan Ganz catheter E. None of the above

A. V/Q scan A V/Q scan is a nuclear medicine study used to evaluate the circulation of air and blood within a patient's lungs in order to determine the ventilation/perfusion ratio.

When in a ventilator mode utilizing PC (Pressure Control), what value must be monitored? A. VTE B. pPlat C. PIP D. PEEP E. High pressure alarm

A. VTE In a ventilator mode utilizing pressure control, this means pressure being delivered with each ventilation is constant. It is important to remember that based on lung compliance the volume delivered with each breath can be variable. This is why it is important to monitor VTE (expired tidal volumes) VTE should be approximately 50 ml within what the expected calculated tidal volume should be.

When in a ventilator mode utilizing PC (Pressure Control), what value must be monitored? A. VTE B. pPlat C. PIP D. PEEP E. High pressure alarm

Select the abnormal ventilator value from the list below: A. Ve 2-4 LPM B. Vt: 4-8 ml/kg/IBW C. FiO2 .21-1.0 D. PEEP 5 cmH2O E. pPlat <30 mmHg

A. Ve 2-4 LPM A normal Ve (minute ventilation) is 4-8 LPM. A normal pPlat is < 30 mmHg A normal FiO2 is .21-1.0 (21-100%) A normal range for PEEP is 5-15 cm H2O ( sometimes higher depending on disease process)

What is the formula for Ve (minute ventilation)? A. Vt x (f) B. (f) x PEEP C. pPlat - PEEP D. Vt - dead space E. Peep + I: time

A. Vt x (f) Ve (minute ventilation) is Vt (tidal volume x f (rate/frequency) A normal minute ventilation is 4-8 LPM.

True or False An I-gel can be utilized with a ventilator. A. Yes B. No

A. Yes An I gel is considered a high-pressure supraglottic airway device and it can be utilized with a ventilator.

True or False Larger amounts of PEEP can cause hypotension. A. Yes B. No

A. Yes Larger amounts of PEEP can increase intrathoracic pressure and cause a decrease in venous return to the heart. This can result in hypotension.

True or False Patients must have a patent airway to be on BiPAP? A. Yes B. No

A. Yes Patients on BiPAP must not have an altered level of consciousness and be able to maintain their own airway.

Your crew is called to transport a 42 y/o female. When you arrive, a paramedic already on scene tells you the patient is experiencing diabetic ketoacidosis. The paramedic also reports that they have intubated the patient and placed her on a mechanical ventilator due to respiratory failure. Upon assessment, you draw an arterial blood sample that returns the following ABG results: pH 7.25; PaCO2 70 mmHg; HCO3- 18 mEq/L. A BMP from the same blood sample also yields a value of K+ 3.8 mEq/L. You begin transporting the patient and repeat the ABG, which displays the following values: pH 7.35; PaCO2 55 mmHg; HCO3- 25 mEq/L. Based on the new ABG values, what do you expect the patient's new K+ value will be? A. +K 3.0 mEq/L B. +K 3.2mEq/L C. +K 2.3 mEq/L D. +K 3.6 mEq/L

B. +K 33.2 mEq/L K+ was initially 3.8 mEq/L. After a 0.10 increase in pH from 7.25 to 7.35, the K+ will likely trend in the opposite direction by 0.6 mEq/L for a new value of 3.2 mEq/L.Remember, there is an inverse relationship between pH and potassium. For every 0.10 change in pH, Potassium will change by 0.6 in the opposite direction

You are transporting a 100 kg patient with a base deficit of -12. How much bicarb would you expect to administer for this patient? A. 150 mEq/L B. 120 mEq/L C. 160 mEq/L D. 200 mEq/L

B. 120 mEq/L BE Formula: 0.1 x (-BE) x kg = Bicarb needed 0.1 x (12) x 100 kg = 120 mEq/L

Ground glass infiltrates are indicative of what disease process on a chest XR? A. Pneumonia B. ARDS C. Asthma D. COPD E. Ruptured AAA

B. ARDS

You have been dispatched to transport a patient from a rural ICU facility. The patient report that you receive from the nurse states that the patient was initially admitted for aspiration pneumonia but has become difficult to ventilate with mechanical ventilation. Currently, the ventilator settings are: A/C-V Vt 320 ml (F) 30 Inspiratory time: 1.5 secs. FIO2 1.0 PEEP 18 cmH2O. The patient is currently in a prone position and has the following ABG pH 7.18 PCO2 31mmHg HCO3 17 mEq/L PaO2 51mmHg Given all of the information available, what is the most likely cause of the patient's condition? A. Kidney failure B. ARDS C. Pulmonary stenosis D. ACS E. Tension pneumothorax

B. ARDS The ventilator settings listed above in conjunction with prone ventilation are indicative of a patient with ARDS.Additionally, a patient that has aspirated is at risk for developing ARDS.

Which of the following causes listed below can create an increased pPlat? A. Mucus plug B. ARDS C. Kinked circuit D. Biting the ETT E. Nebulizer treatment

B. ARDS ARDS is typically caused by a SIRS response that causes cytokine release and makes the alveolar-capillary membrane more permeable. Inflammation then ensues and pulmonary edema develops (non-cardiogenic pulmonary edema). Once the pulmonary edema develops the lungs become stiff and fibrous requiring high pressures to ventilate. This causes an increase in lower airway pressures and a decrease in alveolar compliance.

This mode of ventilation does not let the patient take a spontaneous breath. A. SIMV B. CMV C. A/C D. PRVC E. BiPAP

B. CMV Remember CMV is complete control meaning everything is controlled by the ventilator

Which respiratory pattern is described as progressively deeper and sometimes faster breathing, followed by a gradual decrease that results in a temporary stop in breathing called apnea? A. Biots B. Cheyne-Stokes C. Ataxia D. Apneustic E. Kussmauls

B. Cheyne-Stokes A Cheyne-Stokes respiratory pattern is described as progressively deeper and sometimes faster breathing, followed by a gradual decrease that results in a temporary stop in breathing Aossiciated with Decorticate Posturing (torsades of breathing)

You suspect a patient is suffering from Malignant Hyperthermia. What is the antidote for the patient's condition? A. Epinephrine B. Dantrolene Sodium C. Versed D. Ketamine E. Rocuronium

B. Dantrolene Sodium Dantrolene Sodium is the antidote for Malignant Hyperthermia. Dantrolene Sodium is a muscle relaxant that treats muscle spasms and Malignant Hyperthermia.

What does the "E" in the pneumonic DOPE stand for? A. Exhaustion B. Equipment C. Exception D. Excitability E. None of the above

B. Equipment D: Dislodged (low pressure) O: Obstructed (high pressure) P: Pneumothorax (high pressure) E: Equipment (no pressure)

Which of the following medications listed below that are used in RSI have analgesic properties? A. Etomidate B. Ketamine C. Midazolam D. Diprivan E. All the above

B. Ketamine Ketamine has analgesic, dissociative, and bronchodilation properties.

True or False: Ketamine should not be utilized in RSI when treating patients with adrenal suppression. A. Yes B. No

B. No Ketamine should be used in patients that present with signs and symptoms of shock or adrenal suppression. Ketamine is considered hemodynamically stable and can have transient effects such as increasing the heart rate and blood pressure. Etomidate should not be utilized in patients with adrenal suppression.

True or False Patient's with ARDS often require a prolonged expiratory time. A. Yes B. No

B. No Patients with ARDS often require a prolonged Inspiratory time (I- Time).

True or False In relation to the ventilator, it is important to maintain high levels of PEEP for patients with COPD exacerbation. A. Yes B. No

B. No High levels of PEEP can cause breath stacking and "auto-PEEP" to worsen causing intrathoracic pressures to elevate and breath stacking to increase. COPD=ZEEP

True or False Rocuronium is a depolarizing neuromuscular blocker. A. Yes B. No

B. No Rocuronium is a non-depolarizing neuromuscular blocker. Rocuronium does not cause rapid depolarization of muscles to promote paralysis. Succinylcholine is a depolarizing neuromuscular blocker.

True or False PIP is a reflection of static alveolar compliance and pressure within the lower airways. A. Yes B. No

B. No pPlat is a reflection of the pressure in the alveoli and lower airway pressures.

True or False Patient's with ARDS often require a prolonged expiratory time. A. Yes B. No

B. No Patients with ARDS often require a prolonged Inspiratory time (I- Time). Patients with ARDS have a hard time breathing out. Focus on a PAWP 18-20 and oxygenation with increasing PEEP >10, lowering Vt: <8 cc/kg increase rate (f) to maintain minute volume (Vt x rate= minute volume)

What does the O in LEMON stand for? A. Oxygenate B. Obstruction C. Observe D. Oropharynx E. None of the above

B. Obstruction LEMON is a pneumonic used for a difficult airway assessment and stands for: Look Evaluate, Mallampati Obstruction Neck mobility

You arrive on scene and find a 27 y/o female that is altered and slightly cyanotic. Her sister is also present who tells you the patient has a history of severe asthma attacks and that this episode is consistent with previous instances. After managing the patient's airway, breathing, and circulation, your partner begins to draw an arterial blood gas sample. Which of the following acid/base disturbances will the ABG test most likely reveal? A. Respiratory Alkalosis B. Respiratory Acidosis C. Metabolic Acidosis D. Metabolic Alkalosis

B. Respiratory Acidosis Asthma exacerbations may cause 'breath stacking' due to the inability to exhale. Exhalation facilitates the release of CO2 from the lungs, so we expect this patient to have increased levels of CO2 in their ABG test results. CO2 reacts with H2O in blood, creating H2CO3 (carbonic acid), which contributes to acidosis. Therefore it is a respiratory cause resulting in acidosis.

For every 10 mEq/L change in HCO3-, you can expect the pH to change by: A. .10 B. .08 C. .15 D. .50

C. .15 For every change in HCO3 of 10 mEq/L your pH will change by 0.15 in the same direction.

In this mode of ventilation, the patient is given a set rate and Vt. In addition to the set ventilator rate, the patient also has the ability to trigger a spontaneous breath. With each spontaneous breath taken, the ventilator will deliver the full set amount of volume. ID: FMP-VENT-1019 A. SIMV B. BiPAP C. A/C D. PRVC E. None of the above

C. A/C In Assist Control mode, the patient is given a set rate and Vt. In addition to the set ventilator rate, the patient also has the ability to trigger a spontaneous breath. With each spontaneous breath taken, the ventilator will deliver the full set amount of volume.

You respond to an inter-facility transport request for a 14 y/o male patient experiencing acute respiratory distress. Upon arrival to the sending facility, you perform an assessment and review the patient's notes. Auscultation reveals wheezing and an oral temperature of 37°C. A chest x-ray in the patient's chart reveals hyperinflated lungs with a flattened diaphragm and no infiltrates. An ABG reveals pH 7.21; PCO2 50 mmHg; HCO3- 23 mEq/L; PaO2 70 mmHg. No chronic disease processes are noted in the patient's history. What do you suspect is causing your patient's symptoms? A. Pneumonia B. COPD C. Asthma D. ARDS

C. Asthma The patient has wheezing present with no signs of fever. A flattened diaphragm is consistent with breath stacking and obstructive pulmonary disease.. All of the information is consistent with asthma or COPD. Given the patient is young and has not developed COPD, asthma is the correct choice.

You and your crew are dispatched on an interfacility transport for a 14 y/o female that ingested a large amount of aspirin. Prior to takeoff, you observe the following ABG: pH 7.39; PaCO2 32 mmHg; HCO3- 19 mEq/L. Which of the following acid-base imbalances do you suspect your patient is experiencing? A. Uncompensated Metabolic Acidosis B. Uncompensated Respiratory Acidosis C. Compensated Metabolic Acidosis D. Compensated Respiratory Acidosis

C. Compensated Metabolic Acidosis pH: compensated and below 7.4 CO2: low (alkalotic) below 35 HCO3: low (acidic) below 22 pH and HCO3 are traveling together, therefore this is a compensated metabolic acidosis.

All of the following are treatment modalities for a patient suffering from ARDS except for what? A. Increase PEEP B. Vt < 8cc/KG/IBW C. Decrease PEEP D. High (f) E. None of the above

C. Decrease PEEP Patients with ARDS require high levels of PEEP and a high respiratory rate with a low volume to oxygenate and ventilate.

You have arrived on the scene of a rural ED where a patient has severe wheezing with a rapid respiratory rate present. The patient is noted to be in the "tripod" position and appears to be fatigued. An ABG is obtained upon your assessment and is noted to be the following.pH: 7.15 CO2: 75mmHg HCO3 22 mEq/L PO2: 55 mmHg.Which of the following medications would be the drug of choice for induction in the RSI process? A. Midazolam B. Etomidate C. Ketamine D. Fentanyl E. Anectine

C. Ketamine The patient in the above question is suffering from an obstructive pulmonary process such as asthma or COPD exacerbation due to the expiratory wheezing mentioned in the patient's presentation. Ketamine is the correct choice due to the bronchodilation effects it provides.

ARDS commonly occurs with what disease process? A. Myocardial infarction B. Burns C. Pancreatitis D. None of the above E. All of the above

C. Pancreatitis Pancreatitis sets off a severe SIRS response causing an increased RISK for ARDS. ARDS is caused by Pancreatitis, sepsis, trauma, aspiration pneumonia

This mode of ventilation gives the patient a set rate and volume. However, this mode allows the patient to draw a spontaneous breath and only take the amount of volume that the patient desires. A. A/C B. PRVC C. SIMV D. CMV E. APRV

C. SIMV In Synchronized Intermittent Mandatory Ventilation mode, the patient a set rate and volume. However, this mode allows the patient to draw a spontaneous breath and only take the amount of volume that the patient desires

You respond to a call in a nursing home for an elderly patient with the following ABG values: pH 7.20; PaCO2 35 mmHg; HCO3- 13 mEq/L. In order to return this patient's pH to within normal limits, what would this patient's EtCO2 need to be? A. 25 mmHg B. 45 mmHg C. 55 mmHg D. 15 mmHg

D. 15 mmHg For every 10 mmHg change in EtCO2, the pH changes by 0.08 in the opposite direction. Therefore, if you decrease this patient's EtCO2 to 15mmHg (a change of 20 mmHg), you will increase the patient's 0.16 for a final pH of 7.36.

When utilizing a ventilator, how is using PEEP beneficial? A. PEEP maintains alveolar recruitment B. PEEP prevents atelectasis C. PEEP Improves oxygenation D. All of the above

D. All of the above PEEP (Positive End Expiratory Pressure) can be utilized to maintain recruitment of alveoli, prevent atelectasis of alveoli, and by doing these two things above, improve oxygenation. PEEP helps to prevent atelectasis from occurring by delivering a set positive pressure on exhalation. This helps to "splint" alveoli open. In addition, more alveoli are able to be recruited and this allows gas exchange to occur throughout more surface area of the lung. These two mechanisms help PEEP to improve oxygenation of a patient that is being mechanically ventilated.

You have arrived on the scene of a rural ED where a patient has severe wheezing with a rapid respiratory rate present. The patient is noted to be in the "tripod" position and appears to be fatigued. An ABG is obtained upon your assessment and is noted to be the following.pH: 7.15 PaCO2: 75mmHg HCO3 22 mEq/L PaO2: 55 mmHg Given this ABG, what is an indication to intubate this patient? A. pH B. PCO2 C. PaO2 D. All of the above

D. All of the above All of the above values are indications in which this patient should be intubated. pH: With a pH of 7.15, the patient is in respiratory failure and requires mechanical ventilation in order to excrete acid and bring the pH back closer to a normal range of 7.35-7.45. PaCO2: With a PaCO2 of 75 mmHg the patient is not ventilating well enough to expell CO2 and excrete acid. This is contributing to the patient's low pH. PaO2: With a PaO2 of under 60 mmHg, this patient is not oxygenating effectively.

All of the following are causes of ARDS except for which of the following? A. Pancreatitis B. Sepsis C. Aspiration D. CHF

D. CHF ARDS is caused by pancreatitis, sepsis, trauma, aspiration pneumonia ARDS is considered non-cardiogenic pulmonary edema that is caused by a SIRS response. CHF would cause cardiogenic pulmonary edema.

During a prolonged transport, you monitor your patient's status by recording numerous ABGs. Late in the transport, you notice the patient's EtCO2 has trended upwards by 10 mmHg. You expect the patient's pH to refelct this change by: A. Decreasing by 0.16 B. Increasing by 0.06 C. Decreasing by 1.20 D. Decreasing by 0.08

D. Decreasing by 0.08 For every 10 mmHg change in EtCO2, the pH changes by 0.08 in the opposite direction.

As a critical care provider, you have elected to RSI a patient due to respiratory failure. The patient is diagnosed with Septic shock. Which of the following drugs should not be utilized in the RSI procedure. A. Anectine B. Sublimaze C. Midazolam D. Etomidate E. Ketamine

D. Etomidate Septic shock causes depletion of endogenous catecholamines such as Epinephrine and Norepinephrine. This causes adrenal suppression. Etomidate should not be utilized in adrenally suppressed patients.

You and your partner are called to transport a 36 y/o male suffering from sepsis secondary to pancreatitis. The sending RN provides the following ABG during the handover: pH 7.28; PaCO2 28 mmHg; HCO3- 13 mEq/L. Based on the following ABG, you suspect which of the following acid-base imbalances? A. Compensated Metabolic Alkalosis B. Uncompensated Respiratory Alkalosis C. Partially Compensated Respiratory Alkalosis D. Partially Compensated Metabolic Acidosis

D. Partially Compensated Metabolic Acidosis pH: low and below 7.35 (Acidic) CO2: low (alkalotic) below 35 mmHg HCO3: low (acidic) below 22 mEq/L, pH and HCO3 are traveling together. CO2 is moving in the opposite direction to compensate for acidosis. Therefore, This is a PARTIALLY compensated metabolic acidosis.

You have been called to the scene of a major vehicle accident. On your approach, you see a female patient partially ejected out of the windshield with her head and torso exposed only. The patient has irregular respirations noted at 6 per minute along with trismus present. The patient's pupils are noted to be unequal and she is not responsive. Vital signs are noted to be HR 52 BPM BP 180/105 mmHg SpO2 of 78%. What is the most appropriate treatment for this patient? A. Establish an IO B. Start an IV C. Administer Ketamine IN D. Perform a surgical airway E. Establish an LMA

D. Perform a surgical airway This patient needs to receive immediate oxygenation and ventilation. A surgical airway for this patient is indicated. A surgical airway is going to be both the fastest and easiest method to control the airway and oxygenate/ventilate the patient. This can be done much faster than attempting RSI of a patient that is only partially exposed. It is likely the patient will stimulate a gag reflex when attempting to place a supraglottic device. This can cause possible vomiting and aspiration.

You have been dispatched to transport a patient with respiratory failure. After your assessment, you note the patient's oral temperature to be 38 C and the chest XR to reveal lobar consolidation to the right lower lobe. Based on the information given, what is the most likely cause of the patient's condition? A. Asthma B. ARDS C. COPD D. Pneumonia E. None of the above

D. Pneumonia A body temperature of 38 C signals fever/infection. This coupled with "lobar consolidation" on a Chest XR signals pneumonia.

Select a cause from the list below that would create a low-pressure alarm on the ventilator. A. Right main stem intubation B. Tension pneumothorax C. Mucus plug D. Ruptured ETT cuff

D. Ruptured ETT cuff A ruptured ETT cuff would cause a leak in pressure from the circuit causing a drop in pressure within the ventilator circuit. Low pressure alarms are caused by dislodged tube, disconnection from machine, chest tube leak, circuit leak, airway leak, or hypovolemia

You have arrived at a facility to transport a male patient who was involved in a house fire 36 hours ago. The patient requires RSI due to a rapidly decompensating condition and a PaO2 of 52 mmHg. What drug should be avoided during the RSI procedure? A. Zemeron B. Ketamine C. Etomidate D. Succinylcholine

D. Succinylcholine Patients with severe burns that have been burned > 24 hours become hyperkalemic. Succinylcholine is contraindicated in the presence of hyperkalemia. This drug is contraindicated due to its mechanism of action. When Succinylcholine is administered, all of the acetylcholine receptor sites are flooded and depolarized all at the same time. This reaction of rapid depolarization causes a shift in serum Potassium of approximately 0.5 and can further worsen a hyperkalemic state. Remember trauma sucks (dont give succs following trauma)

You and your crew are called to transport a 73 y/o male in acute respiratory failure secondary to COPD exacerbation. Upon arrival, your crew elects to intubate the patient and place the patient on a mechanical ventilator. Following the intubation, you obtain an arterial blood gas sample with the following results: ph 7.20; PaCO2 35 mmHg; HCO3- 13 mEq/L. Which of the following acid-base disorders do you suspect? A. Uncompensated Metabolic Acidosis B. Compensated Metabolic Acidosis C. Partially Compensated Metabolic Acidosis D. Uncompensated Respiratory Alkalosis

D. Uncompensated Respiratory Alkalosis pH: Low and below 7.35 CO2: NORMAL within 35 to 45 mmHg HCO3: low (acidic) below 22 mEq/L, pH and HCO3 are traveling together. The CO2 is normal and not attempting to compensate. Therefore, this is an UNCOMPENSATED metabolic acidosis

Which of the following treatment modalities are considered beneficial in the treatment of Patient-Ventilator Dyssynchrony? A. Adjust sensitivity B. Manage auto PEEP C. Suction D. Sedation E. All of the above

E. All of the above In a patient with PVD (patient ventilator desynchrony) Dyssynchrony is the effect of the patient's respiratory demands not being appropriately met by the ventilator or inadequate pain and sedation. Sensitivity should be adjusted to ensure the patient is not accidentally triggering the ventilator. The patient should be suctioned, If the sedation is inadequate the patient should be administered additional sedation. Why its Bad:•Increased work of breathing•Increased oxygen demand•Increase heart rate•Increase in BP•Can lead to increase in ICP (CVA's)Treatment:Manage Auto- PEEPAdjust sensitivityAdjust rate (match pt demand)Adjust Minute Volume (Rate x VT)SuctionAdminister analgesia and sedationKetamine, Fentanyl, Versed

During a flight, you are transporting a 75 kg patient that is intubated and being mechanically ventilated. The patient has the following ventilator settings: A/C Volume Vt: 750 mL (f) 22 Inspiratory time: 1.0 sec. PEEP 15 cmH20 FiO2 1.0 During the flight, your high-pressure alarm begins to go off. Which of the following causes listed below could be a cause of the high-pressure alarm? A. Pneumothorax B. Inadequate sedation C. Mucus plug D. Auto "PEEP" E. All of the above

E. All of the above Remember the DOPE pneumonic for high and low-pressure ventilator alarms.Dislodgement (low pressure) Obstruction (mucus, biting tube, a kink in circuit tubing, bronchospasm) (high pressure) Pneumothorax (high pressure) Equipment.

Which medication would be helpful in the treatment of Asthma exacerbation? A. Brethine B. Mag Sulfate C. Dexamethazone D. Xopenex E. All the above

E. All the above All the above medications are useful in the treatment of asthma. Brethine, Albuterol, Xopenex: Beta 2 agonists and smooth muscle relaxation. Dexamethasone: decreases inflammation in the airways. Mag Sulfate: provides smooth muscle relaxation and bronchodilation.

Which of the following listed tidal volumes is within an appropriate range for a patient with an IBW of 80KG? A. 480 ml B. 400 ml C. 320 ml D. 560 ml

E. All the above Vt (Tidal Volume) = 4-8 cc/kg•How much air is delivered per breath•Excessive Tidal Volume can lead to Ventilator-Induced Lung Injury (VILI) Ideal body weight Males: IBW = 50 kg + 2.3 kg for each inch over 5 feet. Females: IBW = 45.5 kg + 2.3 kg for each inch over 5 feet. 80*4=320 80*8=640

Which of the following would indicate a potentially difficult airway? A. Hypoxemia B. Extremes in size C. Vomit/blood in the airway D. Exsanguination E. All the above

E. All the above Remember the HEAVEN criteria for difficult airways. Hypoxemia, Extremes in size, Anatomical challenges, Vomit/blood/ in the airway, Exsanguination, Neck mobility.

pH: Normal and fully compensated (7.42) CO2: low (alkalotic) below 35 mmHg pH and CO2 are traveling opposite of each other making the respiratory system the offender. HCO3: low (acidic) below 22 mEq/L. This is compensating for respiratory alkalosis. Using 7.4 as a perfect pH, 7.42 is closer to the alkalotic range making this a fully compensated alkalosis. CO2 is low and also alkalotic. HCO3 is low (acidic). pH and CO2 are traveling opposite of each other making this a compensated respiratory alkalosis.

Airway, ABG, and Flight

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