Crit Care 2: Page 66-75

Question 1

Two things to do to minimize ICU weakness

Answer 1

early mobilization and management if hyperglycemia

Question 2

Two measurements indicating decreased oxygenation

Answer 2

Decreased O2 saturation

Wide A-a

Question 3

Inspiratory stridor suggests obstruction where?,

Answer 3

at or above the vocal cords

Question 4

expiratory stridor and wheezing suggest?

Answer 4

an intrathoracic process

Question 5

Main causes of shunts

Answer 5

alveolar collapse (atelectasis) and alveolar filling with blood, cells, protein, or water

Question 6

____ is the most common complication after smoke inhalation

Answer 6

Pneumonia, especially from Staphylococcus and Pseudomonas species.

Question 7

cholinesterase inhibitor exposure treatment

Answer 7

high-dose atropine is administered until bronchorrhea and bronchospasm are controlled.

Question 8

What general finding on histology in ARDS

Answer 8

diffuse alveolar damage

Question 9

Clinical features of Ammonia toxicity

Answer 9

Cough, upper airway burns, pulmonary edema, asphyxiation in poorly vented areas

Question 10

Clinical features of Chlorine toxicity

Answer 10

Upper airway irritation and burns, bronchospasm, pulmonary edema

Question 11

Clinical features of phosgene toxicity

Answer 11

Systemic toxicity, including elevated methemoglobin level, cyanosis, and metabolic acidosis; pulmonary edema

Question 12

Clinical features of musard gas toxicity

Answer 12

Upper airways burns and obstruction can occur

Question 13

Clinical features of organophosphates inhibitor toxicity

Answer 13

Systemic toxicity causing acetylcholine toxicity (rhinorrhea, bronchorrhea, diarrhea, bronchospasm, bradycardia, flaccid paralysis, apnea)

Question 14

Six direct pulmonary injuries that are common causes of ARDS

Answer 14

Aspiration of gastric contents

Fat embolism

Near drowning

Pneumonia (including viral causes such as COVID-19)

Smoke or chemical inhalation

Thoracic trauma/thoracic contusion

Question 15

Six indirect pulmonary injuries that are common causes of ARDS

Answer 15

Disseminated intravascular coagulation

Nonthoracic trauma

Pancreatitis

Pulmonary reperfusion injury (after lung transplantation)

Sepsis/septic shock

Transfusion of blood products

Question 16

The compliant lung is susceptible to____

Answer 16

(volutrauma)

Question 17

Recomended tidal volumes plateau pressures

Answer 17

guidelines recommend a tidal volume of 4 to 8 mL/kg of predicted body weight and a plateau pressure less than 30 cm H2O.

Question 18

What ventilator variable prevents atelectotruama

Answer 18

PEEP

Question 19

PO2/FIO2 ratio less than ___ should be proned 12-16 hrs a day

Answer 19

150 and on 60% FiO2

Question 20

Although mortality did not differ between groups, patients who were treated with _____ fluid management showed improved oxygenation and decreased time on the ventilator and in the ICU.

Answer 20

Conservative

Question 21

In cardiogenic pulmonary edema________, hastens the resolution of hypoxemia, improves symptoms, lowers intubation rates, and decreases mortality compared with oxygen therapy alone.

Answer 21

noninvasive positive pressure ventilation (continuous positive airway pressure or bilevel positive airway pressure)

Question 22

_______ is a common postoperative complication

Answer 22

Atelectasis

Question 23

Because outcomes after intubation and mechanical ventilation are very poor for patients with acute exacerbations of idiopathic pulmonary fibrosis, goals of care and palliative care strategies should be discussed early and other therapies, such as extracorporeal membrane oxygenation, should only be offered as a bridge for patients eligible for ______

Answer 23

lung transplantation.

Question 24

In the patient with PE and RV dysfunction. Increased intrathoracic pressures from mechanical ventilation can 1. _____ venous return and RV preload. 2_____ alveolar pressures can compress capillaries and 3.____ RV afterload.

Answer 24

1. Decrease
2. Increased
3. Increase

Question 25

Why do all patients who are suspected of acute hypercapnic respiratory failure need arterial blood gas analysis even if hypoxemia resolves with oxygen administration

Answer 25

Fixing oxygenation can worsen hypercapnia via: V/Q mismatch, decreased respiratory drive, and the Haldane effect

Question 26

Which obstructive airway disease has an elevated baseline PCO2

Answer 26

CODP

Question 27

In which which obstructive airway disease does an elevated PCO2 indicate probable respiratory demise

Answer 27

Asthma

Question 28

Arterial blood gases should be monitored within ___ hours of initiation of NPPV

Answer 28

2

Question 29

How to treat obesity hypoventilation syndrome

Answer 29

Noninvasive ventilation with bilevel positive airway pressure or volume-targeted pressure support

Question 30

Pulmonary Function Values Suggestive of Neuromuscular Weakness FVC: Maximal inspiratory pressure: Maximal expiratory pressure:

Answer 30

FVC: >20% decrement in FVC while supine compared with upright position Maximal inspiratory pressure: Less than −60 cm H2O or 50% of predicted Maximal expiratory pressure: Less than +60 cm H2O or 50% of predicted

Question 31

Two most common causes of acute neurologic respiratory failure in the ICU

Answer 31

Guillain-Barré syndrome and myasthenic crisis

Question 32

How to reduce autopeep

Answer 32

prolong the expiratory time (with lower respiration rate) and administer bronchodilators.

Question 33

Three reasons why excessive oxygenation in CODP is bad

Answer 33

increasing V/Q mismatch, decreasing respiratory drive, and the Haldane effect

Question 34

Is there evidence to support NPPV in asthma exacerbations

Answer 34

not really