Dave's Final
APRV (airway pressure release ventilation)
SIMV-PC provides two evels of CPAP and allow spontaneous breathing at both levels when spontaneous effort is present. applies CPAP (P high) for a prolonged time (T high) to maintain adequate lung volume and alveolar recruitment, with a time-cycled release phase to a lower set of pressure (P low) for a short period of time (T low) or (release time) where most of ventilation and CO2 removal occurs
A patient who is breathing spontaneously with signs of pneumonia exhibits diaphoresis, tachypnea, hypotension, and metabolic acidosis. An adult critical care specialist should anticipate that this patient will receive treatment for Renal Failure Hepatic Failure Sepsis DKA
Sepsis Note: Metabolic acidosis has three main root causes: increased acid production, loss of bicarbonate, and a reduced ability of the kidneys to excrete excess acids.
A patient is admitted to the intensive care unit with increased oxygen demand, slight fever, and thick yellow sputum. Lab results show WBC 15,000 cells/mm3, RBC 4.8 million/mm3, and platelets 200,000/mm3. Sputum gram stain discovered gram-negative rods. Which of the following is the most likely cause? Bacterial pneumonia Rhabdomyolisis Pleural effusion Renal failure
Bacterial pneumonia Pseudomonas aeruginosa, and E. coli (Bacterial)
midazolam hcl (versed)
Benzo (anesthetic) inhibit GABA widely distributed, crosses BBB onset: 1-5 min duration: 1-2 hr highly protein bound met in liver to active met t1/2: 1-4 hr used before medical procedures and surgery to cause drowsiness, relieve anxiety, and prevent any memory of the event. It is also sometimes given as part of the anesthesia during surgery to produce a loss of consciousness.
septic shock signs and symptoms
Bounding pulses WARM extremities tachycardia ↓ BP Cool, Clammy Pale mottled skin altered consciousness
A patient has an Sp02 of 85% respiration of 28/min, rhonchi auscultated in all lungs fields and ineffective cough. The patient has a history of Cystic fibrosis and requires frequent suctioning as the high-pressure alarm sounds regulatory. the attending physician asks the RT what frequency the suction order should be written for. the critical care respiratory therapist would recommend Q30 min Q2 Q4 PRN based on peak pressure values
PRN based on peak pressure values
Which of the following interval/segment is not part of ECG Components QT interval PT interval PR interval QRS interval
PT interval
During the early stages of a lung abscess, the pathological process is the same as that of: Bronchopulmonary dysplasia Pulmonary fibrosis Pulmonary edema Pneumonia
Pneumonia
Which of the following should be measured to determine whether pleural fluid is an exudate or transudate? amylase Sodium Glucose Protein
Protein
An adult patient arrives with an acute exacerbation of cystic fibrosis. Sputum culture reveals many gram-negative rods. Which of the following is the MOST likely organism? Staphylococcus aureus Haemophilus influenzae Aspergillus fumigatus Pseudomonas aeruginosa
Pseudomonas aeruginosa
A patient is noted to have dangerously low hemoglobin levels. The physician recommends a blood transfusion but the patient refuses based on religious beliefs. Which of the following is the appropriate action? Call the hospital lawyer to take the case to court Refuse to treat the patient Provide the blood transfusion without consent Treat the disease process along with the standard of care without the transfusion
Treat the disease process along with the standard of care without the transfusion
Replacement of single-use suction catheters with in-line catheters is primarily intended to decrease. labor costs. supply expenditures. occupation-related infections. VAP
VAP
nitroprusside sodium (Nipride)
Vasodilator (decreases BP)
Nitroprusside (Nipride)
Vasodilator; Antihypertensive
A patient with asthma develops a significant pneumothorax on the right side. A large air leak is noted following right chest tube insertion. Patient data while receiving VC, A/C ventilation with an FIO2 of 0.60 are: pH 7.24 PaCO2 52 Torr PaO2 55 Torr HCO3- 22 mEq/L BE -6 mEq/L Set Vt 500 mL Exhaled Vt 150 mL Which of the following is the MOST appropriate recommendation? independent lung ventilation ECMO APRV PCV
independent lung ventilation #pneumothorax
A 60-year-old male with asthma is admitted to the ICU with increasing dyspnea and a cough that produces sputum. A Gram stain reveals gram-negative rods and polymorphonuclear leukocytes. Which of the following should an adult critical care specialist anticipates intravenous antibiotics inhaled corticosteroids an enzymatic mucolytic hypertonic saline
intravenous antibiotics (Pseudomonas aeruginosa, and E. coli (Bacterial)
A 47-year-old patient is undergoing therapeutic bronchoscopy for left lung atelectasis. An adult critical care specialist notes that saline is not being suctioned through the scope. The specialist should FIRST irrigate the suction channel. decrease suction pressure. obtain a chest radiograph. reposition the bronchoscope.
irrigate the suction channel
A 49-year-old female is receiving mechanical ventilation after an exacerbation of asthma led to respiratory failure. The nurse notifies an adult critical care specialist that the patient's oxygen saturation has dropped from 96% to 84%. The nurse states that the patient has decreased breath sounds and the ventilator keeps alarming. The specialist should FIRST deliver 100% O2 through the ventilator. manually ventilate with 100% O2. order a STAT chest radiograph. request a replacement ventilator.
manually ventilate with 100% O2
A 56-year-old male patient with terminal lung cancer has severe dyspnea. The patient has persistent nausea and vomiting and refuses IV placement. The physician asks an adult critical care specialist to recommend aerosolized medication to relieve dyspnea. The specialist should suggest? furosemide (Lasix). morphine. albuterol. midazolam HCl (Versed).
morphine
transudate
noninflammatory fluid that resembles serum but with slightly less protein Transude: pass through a membrane, filtered through, transversed a membrane
A patient has just had placement of a chest tube to enable right thoracostomy for talc pleurodesis to treat chronic bronchopleural fistula. The patient is receiving VC, A/C ventilation following respiratory failure associated with an exacerbation of asthma. Ventilation settings and physiologic data are: FiO2 40% Rate 10 Vt 450 mL PEEP 10 cm H20 Exhaled Vt 4000 Spo2 96% On exam, crepitus is palpated over the right chest wall, and a persistent air leak is noted. Which of the following should be done FIRST? Increase VT to 550 mL. Clamp the chest tube. Reduce to 5 cm H2O PEEP. Increase suction.
Reduce to 5 cm H2O PEEP.
Of the following what is the most key piece of information gathered during a physical assessment by the respiratory therapists Respiratory Rate/Breath Sounds/Pattern Heart Rate and Rhythm Glasgow Coma Score Skin assessment
Respiratory Rate/Breath Sounds/Pattern
Which of the following steps is not included with a physical assessment? Inspection Auscultation Reviewing chief complaint Palpation
Reviewing chief complaint
A 28-year-old male presents to the intensive care unit after a motor vehicle collision. He is mechanically ventilated and sedated. The patient's urine in the drain bag is the color of dark tea. Urinalysis is pending. Which of the following is the most likely condition? Septic shock Rhabdomyolysis Bacterial pneumonia Critical illness polyneuropathy
Rhabdomyolysis
An adult critical care specialist is assisting with the care of a 20-year-old patient who was admitted less than 24 hours ago with influenza. The patient was intubated after her condition rapidly deteriorated. A chest radiograph reveals bilateral infiltrates and the patient is hypoxemic. Which of the following ventilation strategies is MOST appropriate? PC ventilation with 40 cm H2O PIP inverse ratio ventilation at 2:1 tidal volume target of 6 mL/kg of IBW plateau pressure below 40 cm H2O
tidal volume target of 6 mL/kg of IBW
sepsis
toxic inflammatory condition arising from the spread of microbes, especially bacteria or their toxins, from a focus of infection Dangerous infection of the blood
haloperidol (Haldol)
An antipsychotic drug thought to block receptor sites for dopamine, making it effective in treating the delusional thinking, hallucinations and agitation commonly associated with schizophrenia.
An RT encounters the following ECG Strip while performing a routine ECG in the ED What should the RT do FIRST? Check lead III for contact Start cooling protocol Complete the ECG and report the results in the EMR Call a rapid response/Code
Call a rapid response/Code
A 22-year-old female patient is intubated and mechanically ventilated following an asthma exacerbation. Which of the following strategies will reduce the likelihood of the development of excessive autoPEEP? Longer inspiratory time Longer expiratory time Higher PEEP Lower flow rate
Longer expiratory time
An 80 yo female with COPD recently underwent hip replacement surgery and is receiving morphine for pain. A rapid response is called because the patient has had a mental status change. The adult acute care practitioner find the patient to be lethargic with a Glasgow coma scale of 12, pinpoint pupils. The patient has the following values while receiving 6 L/min supplemental oxygen via nasal cannula: pH 7.30 BP 138/79 mmHg PaO2 68 mmHg RR 16 /min PaCO2 88 mmHg HR 120 /min HCO3 39 Temp. 36 Degree C. Which of the following should the adult critical care specialist recommend FIRST? Intubate with mechanical ventilation 5.0 mg inhaled albuterol by nebulizer 0.04mg Naloxone HCI (narcan) by IV 8.0 cmH2O CPAP mask
0.04mg Naloxone HCI (narcan) by IV
Normal Hb levels
12-14 g/dL
A family presents in the ER after their home carbon monoxide detectors started alarming last night. All family members are currently placed on non-rebreather masks and awaiting blood gas results. At what level of COhb is Hyperbaric Treatment typically necessary? 25% 15% 5% 10%
15%
A core part of the decision-making process is when to start critical care intervention (CPR/Intubation) which of the following situations does not require critical intervention? A trauma 2 patient with GCS of 3 65-year-old apneic patient An 18-year-old patient presenting with wheezing and high work of breathing A new-born baby with Apgar of 0
An 18-year-old patient presenting with wheezing and high work of breathing
what does continuous bubbling of the water-seal chamber of a chest tube?
Air leak The water in the water-seal chamber should rise with inhalation and fall with exhalation (this is called tidaling), which demonstrates that the chest tube is patent. Continuous bubbling may indicate an air leak, and newer systems have a measurement system for leaks — the higher the number, the greater the air leak.
Which type of infection control measures should the healthcare provider put in place for a patient who is being admitted with a diagnosis of active pulmonary tuberculosis (TB)? Contact precautions Airborne precautions Droplet Precautions Positive pressure precautions
Airborne precautions
Which of the following are appropriate options for preventing ventilator-associated pneumonia (VAP)? I. intubated with a "hi-lo evac tube." II. Maintaining head of bed 30 degrees or higher III. Oral decontamination at frequent intervals IV. Heated wire ventilator circuits
All of the above: intubated with a "hi-lo vac tube." Maintaining head of bed 30 degrees or higher Oral decontamination at frequent intervals Heated wire ventilator circuits
Which of the following breathing patterns would be the most concerning to you as an RT? Ataxic Asthmatic Cheyne-stokes Breathing Apnea None of the above
Apnea
A patient is admitted to the ICU after a motor vehicle crash. Ribs 4 through 7 are broken and a pneumothorax is present. A chest tube is placed. VC, A/C ventilation is initiated with the following settings: FiO2 80% Rate 10 PIP 26 cm H20 PEEP 6 cm H20 One hour later, the nurse notifies an adult critical care specialist that the low minute volume alarm is sounding continuously and peak pressure varies from 16 to 20 cm H2O. Which of the following should the specialist do FIRST? Replace the endotracheal tube. Check the water seal chamber. Clamp the chest tube. Switch to PC ventilation
Check the water seal chamber. It will help identify whether the problem is in the circuit or a relapsed pneumothorax The water in the water-seal chamber should rise with inhalation and fall with exhalation (this is called tidaling), which demonstrates that the chest tube is patent. Continuous bubbling may indicate an air leak, and newer systems have a measurement system for leaks — the higher the number, the greater the air leak.
A patient presents to the ER with a recent onset of headache and dizziness while camping in his car. He has difficulty breathing and increased vital signs. The pulse oximetry monitor is reading 100% on room air. What test should be ordered to help with a differential diagnosis? Sleep Study Toxicology DLCO Co-oximetry
Co-oximetry
A 5-year-old patient comes into the respiratory suction clinic for an evaluation. The mother reports secretions over the past few days and fussy eating habits. A base-line assessment comes back as a 1 for respiratory distress (Normal Rate and rhythm, no retractions), 1 for cardiac distress (color and cap-refill) and 1 for level of consciousness the RT should do the following (follows commands). Suction the patient and reassess Educate the mother and send the patient home Start the patient off on 2 LPM O2 Call the Pediatric physician for a second evolution
Educate the mother and send the patient home
What is exudative and Transudative pleural effusion?
Exudative pleural effusions occur when the pleura is damaged, e.g., by trauma, infection or malignancy, and transudative pleural effusions develop when there is either excessive production of pleural fluid or the resorption capacity is reduced.
A 67-year-old male is admitted to the intensive care unit. A flow-directed, balloon-tipped pulmonary artery catheter is in place. The patient is short of breath, diaphoretic, and anxious. Breath sounds reveal crackles in the bases. The critical care specialist notes +2 pitting edema in the lower extremities. Which of the following is the most appropriate intervention at this time? Enoxaparin (Lovenox) Furosemide (Lasix) Nitroprusside (Nipride) Dopamine (Dobutrex)
Furosemide (Lasix)
A 71-year-old male patient is admitted with an exacerbation of COPD. He complains of increasing shortness of breath and chronic cough. He continues to smoke approximately 1.5 packs of cigarettes per day. Which of the following lab values would the critical care specialist expect to see for this patient? Increased methemoglobin Increased troponin Hyperkalemia Increased carboxyhemoglobin
Increased carboxyhemoglobin
A 58-year-old male is admitted to the intensive care unit after an acute myocardial infarction. He is intubated, mechanically ventilated, and sedated. A flow-directed, balloon-tipped pulmonary artery catheter is in place. The following patient assessment is noted. HR 118/min RR 18/min SpO2 91% on 0.8 FiO2 PCWP 10 mmHg PAP 42/21 mmHg CVP 2 mmHg Which of the following intervention is most appropriate at this time Lovenox Coumadin Normal saline bolus Inhaled nitric oxide
Inhaled nitric oxide low to high pressure bt CVP and PAP
A 48-year-old patient is noted to have a normal sinus rhythm on the cardiac monitor but the patient is unresponsive, apneic, and pulseless. Which of the following is the most appropriate course of action? Prepare for synchronized cardioversion Initiate CPR immediately Prepare for anticoagulation infusions Obtain a stat 12 lead ECG
Initiate CPR immediately
A 76-year-old male is 1-day post-motor vehicle trauma with bilateral lower extremity fractures and a small subdural hematoma. The patient is receiving VC ventilation. Which of the following should an adult critical care specialist recommend to limit the likelihood of pulmonary embolus? Initiate oral warfarin (Coumadin). Initiate external pneumatic compression devices. Administer low molecular weight heparin. Insert a retrievable inferior vena caval filter.
Insert a retrievable inferior vena caval filter.
A 61-year-old female is brought to the emergency department by her daughter with a chief complaint of sudden onset of confusion. While in the emergency department waiting room, the patient collapses. The critical care specialist notes that the patient has a regular pulse and spontaneous respiratory rate of 6/min with sonorous upper airway sounds. Which of the following is the most appropriate intervention? Apply cricoid pressure and oxygen via a non-rebreathing mask Initiation of CPR Intubation Initiation of NIV
Intubation
RSV is confirmed in a 6-month-old infant with severe BPD. Respiratory symptoms have worsened over 24 hours. The infant is receiving O2 at 8 LPM by HFNC with an FIO2 of 100% which of the following should the neonatal specialist anticipate? Suctioning the patient Intubation and mechanical ventilation Oral antibiotics Continuous albuterol
Intubation and mechanical ventilation
Ketorolac (Toradol)
NSAID Pain relief due to prostaglandin inhibition may decrease effectiveness of hypertensive medications and diuretics
what meds can go down the ET tube (NAVEL)
Narcan Atropine vasopressin epinephrine lidocaine
A patient is immediately post-lobectomy and is receiving VC, A/C ventilation with the following settings and physiologic data: FiO2 50% Rate 12 Vt 500 mL PEEP 5 cm H20 Exhaled Vt 350 Spo2 90% Marked bubbling is observed in the water seal chamber. The tubing is checked and connections are secure. After notifying the surgeon, which of the following should an adult critical care specialist do NEXT? Increase negative pressure on the chest tube. Clamp the chest tube. Order a chest radiograph. Set 10 cm H2O PEEP.
Order a chest radiograph. Bubbling in the Water Seal Chamber May Mean an Air Leak If the water seal is continuously bubbling, you should suspect an air leak. Think of the lungs as wrapped in plastic. An air leak occurs when there is a hole in the plastic wrap allowing air to escape from the lung tissue into to the pleural cavity.
Which of the following hemodynamic findings would necessitate the use of an inhaled pulmonary vasodilator? (like nitric) PAP 38/17 mm Hg CO. 3.5 L/min SVR 1624 dynes/sec/cm CVP 8 mm Hg
PAP 38/17 mm Hg
A 175-cm (5-ft 9-in) tall, 95-kg (209-lb), male patient with no history of pulmonary disease arrives in the ICU for treatment of pulmonary embolism. The patient is hemodynamically stable with a SpO2 of 90%. VC, SIMV settings are: FiO2 0.60 Vt 600 mL PEEP 5 cm H20 A chest radiograph shows left lower lobe atelectasis. Which of the following should an adult critical care specialist increase? inspiratory flow rate PEEP FIO2 tidal volume
PEEP
gum elastic bougie device
Several terms are used to describe the classic ETI (endotracheal tube introducer) Although the phrase "gum elastic bougie" is common, we find it confusing since the ETI is neither gum nor elastic and is not used as a bougie (ie, dilator). The ETI consists of a 50- to 60-cm stylet with the distal tip bent at a 30 degree angle. The bend allows the intubator to direct the tip anteriorly under the epiglottis and through the vocal cords, which may not be visible.
A patient with COPD had an episode of acute-on-chronic respiratory failure. The patient is receiving VC, A/C ventilation with the following settings and BG Values: FIO2 0.4 PH 7.35 Mandatory Rate 10 BPM Pco2 50 torr Vt 600 mL PaO2 61 Torr PEEP 5 cm H20 HCO3- 26 mEq/L Flow Rate 40 L/Min BE +2 mEq/l The physician wants to wean the patient. Which of the following should an adult critical care specialist suggest? Increase FIO2 to 0.50. Change to SIMV mode with a backup rate of 6/min. Start daily spontaneous breathing trials. Decrease to 3 cm H2O PEEP.
Start daily spontaneous breathing trials
Which of the following sign is typically associated with a croup diagnosis? Alerted level of consciousness Thumb sign x-ray Steeple sign x-Ray Increased sections
Steeple sign x-Ray
Which of the following will produce short-term paralysis in a 10-month-old child prior to intubation? Bloxiverz Alcuronium Succinylcholine Chloride Activase
Succinylcholine Chloride
What is the typical treatment for a patient with non-critical RSV? Intubation and mechanical ventilation fluid replacement therapy Albuterol q2 Suction as needed
Suction as needed
A 25 y/o female has been admitted to the ED for fatigue. She recently passed out at work and is very dizzy. The attending doctor orders an ABG while on 2 lpm NC, that returns the following results pH 7.35 PaO2 45 mmHg PaCO2 mmHg HCO3 24 HGB 6.0 g/dL spO2 91% OXHB 90% COHGB 0.0% Met HGB 0.0% What should the RT recommend as a treatment? Transfusion PRBC Platelet transfusion Transfusion of FFP Give IV fluids at 40 ml/kg/min for 25 minutes
Transfusion PRBC Normal: 12-14 g/dL
Dopamine (Dobutrex)
catecholamines used to treat low blood pressure (hypotension), low cardiac output, and reduced perfusion of body organs due to shock, trauma, and sepsis.
When should a physical assessment be discounted and moved on to the next level of assessments? When a critical life function is disrupted When all necessary information has been gathered When the patient refuses to cooperate When the cause of the chief complaint is determined
When all necessary information has been gathered
An adult critical care specialist responds to a blood pressure alarm from an indwelling arterial line. Pressure reads 80/60 mm Hg, and the waveform appears dampened. Which of the following is the MOST likely cause of these findings? air in the system faulty transducer closed stopcock incorrect transducer position
air in the system
dampened waveforms
air in the system
Rhabdomyolisis
destruction of muscle that stores and transports oxygen
A 52-year-old female patient who is post-myocardial infarction has just been intubated for respiratory failure. To decrease anxiety and relieve dyspnea, the physician ordered a 500-mcg/kg propofol (Diprivan) bolus, and a continuous IV drip at 25 mcg/kg/min has been running for 10 minutes. The following changes are noted: Pre-infusion HR 110/min RR 30/min BP 138/95 mmHg SPO2 90% Post-infusion HR 110/min RR 12/min BP 88/64 mmHg SPO2 96% The patient appears comfortable. An adult critical care specialist should expect the physician to... initiate a dopamine HCl infusion. discontinue propofol (Diprivan). Change to a morphine drip. continue the current sedation treatment.
discontinue propofol (Diprivan).
Which of the following BEST prevents VAP for a patient with a history of TB? inhaled antibiotics frequent ventilator circuit changes early extubation to NPPV percutaneous tracheostomy
early extubation to NPPV
An 80-year-old patient who is intubated, and has third-degree burns over 85% of his body, is in extreme pain. The patient and family request a DNR order and comfort care measures only. The burns have complicated venous access, so an IV has not been started. Which of the following is the BEST recommendation for analgesia? endotracheal ketorolac (Toradol) instillation a transdermal lidocaine HCl (Xylocaine) patch a transdermal fentanyl (Duragesic) patch endotracheal morphine instillation
endotracheal morphine instillation
exudate
fluid, such as pus, that leaks out of an infected wound any fluid released from the body with a high concentration of protien, cells, or solid debris fluid that passes through a membrane criteria for fluid being exudate are: Pleural fluid protein to serum protein ratio > 0.5, Pleural fluid LDH to serum LDH ratio > 0.6, and/or pleural LDH > 2/3rds (i.e. 0.67 times) the upper limit of normal for serum LDH)
Naloxone HCI (narcan)
opioid antagonist
A 65 y/o male patient has been rushed to the ED by his family after he indicated he was having some chest pain after he mowed the lawn. the attending physician orders an ECG with the following results what should the RT indicate as the first course of action? give an IV bolus of Levophed place the patient on oxygen call a rapid response/code start cooling therapy
place the patient on oxygen
A patient with a pulmonary embolism requires intubation, but the airway is difficult to visualize by direct laryngoscopy. A video laryngoscope has been selected. Which of the following is MOST likely to facilitate intubation with this device? gum elastic bougie device size 4 Miller blade fiberoptic bronchoscope preformed rigid stylet
preformed rigid stylet #difficultIntubations #videoLaryngascope
A patient with asthma required continuous IV sedation to manage invasive mechanical ventilation. Which of the following BEST facilitates daily sedation interruption for this patient? propofol (Diprivan) morphine haloperidol (Haldol) lorazepam (Ativan)
propofol (Diprivan)
A 40-year-old patient with lymphocytic leukemia is neutropenic after a course of intravenous chemotherapy 1 week ago. The patient was admitted due to an acute drop in blood pressure to 80/50 mm Hg with a HR of 120/min and a temperature of 38.0 C. Following administration of a fluid bolus, the patient has a HR of 110/min and a BP of 90/45 mm Hg. Which of the following types of shock does this presentation MOST likely indicate? anaphylactic septic cardiogenic Neurogenic
septic
transudate vs. exudate
transudate fluid created as a result of changes in hydrostatic pressure. E.g. Cirrhosis, Heart Failure, Nephrotic Syndrome, Superior Vena Cava Obstruction. Here, only fluid moves from the intravascular space into the extravascular space. There is no inflammation of the vessels and so proteins don't move out. exudate fluid created as a result of an inflammatory process. The walls of the vessels are inflamed, the spaces between endothelial cells are increased, and both proteins and fluids leak into the surrounding tissue to form fluid there. E.g. Pulmonary Embolus, Pneumonia, etc. The protein and lactate dehydrogenase (LDH) levels in pleural fluid can help differentiate between transudative and exudative effusions. criteria for fluid being exudate are: Pleural fluid protein to serum protein ratio > 0.5, Pleural fluid LDH to serum LDH ratio > 0.6, and/or pleural LDH > 2/3rds (i.e. 0.67 times) the upper limit of normal for serum LDH)
A 70-year-old male patient who is in the ICU has pneumonia. Heart rate is 92/min, and blood pressure is 220/130 mm Hg. A physician orders an infusion of nitroprusside sodium (Nipride). An adult critical care specialist should anticipate an increase in cardiac preload. ventilation/perfusion mismatch. PaO2/FIO2. pulmonary arterial pressure.
ventilation/perfusion mismatch. nitroprusside is a vasodilator that decreases BP/
