Respiratory

Question 1

What are critical blood gas results?

Answer 1

Ph less than 7.2, Paco2 >55, Pa02 <60

Question 2

Calculate minute volume

Answer 2

Minute Volume (Ve) = Tidal Volume (Vt) x Rate (f)

Question 3

S/S of Acute Resp Distress?

Answer 3

Rapid, shallow breathing, accessory muscle use, tripod, decrease minute volume, critical ABG results, changing breath sounds

Question 4

What is a shunt?

Answer 4

No perfusion of alveolar beds causing no gas exchange

Question 5

Classic Pulmonary Embolism patients

Answer 5

Smokers, birth control, surgery, cancer, pregnant, obese

Question 6

Treatment of P.E.

Answer 6

High flow 02, Lovenox/Heparin, Fibrinolysis (TPA), Surgery

Question 7

Signs of P.E.

Answer 7

Acute Resp Distress, Spo2 not responding to high flow 02. Elevated D-Dimer.

Question 8

S/S of COPD/Asthma/Bronchitis

Answer 8

Bronchoconstriction, Hypersecretion and edema, Trouble breathing OUT

Question 9

Treatment of COPD/Asthma/Bronchitis

Answer 9

Albuterol, Atrovent, Magnesium sulfate, Steroids. Ketamine for induction agent (bronchodilator)
Increase I:E ratio to 1:3 or 1:4

Question 10

Causes of Pneumonia

Answer 10

Ventilator acquired VS Community acquired. Can be viral, bacterial, or fungal.

Question 11

Treatment of Pneumonia

Answer 11

O2, IV antibiotics, HOB elevation of 30*, Suction mouth and upper airway PRN, Supportive treatment.

Question 12

Define Adult Respiratory Distress Syndrome (ARDS)

Answer 12

Hyperpermeable pulmonary capillaries causing interstitial fluid build up causing separation of alveoli and capillary bed (shunt forms).

Question 13

Treatment of ARDS

Answer 13

PEEP of 5-20, Recruit alveoli and provide O2, Monitor PIP, Vt, and Pplat.

Question 14

What is normal tidal volume for the obstructive approach to ventilator management?

Answer 14

6-10 ml/kg

Question 15

Clinical signs of Pneumothorax

Answer 15

SOB, Absent lung sounds on one side, JVD, hypotension, tachycardia.

Question 16

Treatment of Pneumothorax

Answer 16

Remove from Vent / PPV! Needle chest decompression or chest tube.

Question 17

Criteria for Intubation

Answer 17

Current airway patency (trauma, unable to swallow)
Oxygenation or Ventilation failure (pH <7.2, Co2>55, PaO2 <60)
Expected clinical course
Gcs<8

Question 18

Ventilator CMV mode

Answer 18

Delivers Vt or PIP at preset rate. Cannot initiate breaths.

Question 19

Ventilator AC mode

Answer 19

Delivers preset Vt or PIP. Able to trigger full breaths. Can cause breath stacking or autopeep.

Question 20

Ventilator IMV mode

Answer 20

Provides preset Vt or PIP while allowing patient to take own breath and volume without delivering full breath.

Question 21

Ventilator SIMV mode

Answer 21

Considered safest mode. Allows for variation of support from complete support to spontaneous breathing.

Question 22

Ventilator High Pressure alarm troubleshooting

Answer 22

Suction tube/patient, Connections secured and not kinked, check for obstructions, pneumothorax, ETT displacement (main stem).

Question 23

Ventilator Low Pressure alarm troubleshooting

Answer 23

Think disconnect! Check all connections starting at patient and working back. Check O2 delivery/supply, Check for leaks in vent circuit, ETT displacement (dislodged)

Question 24

Ventilator Low Spo2 alarm troubleshooting

Answer 24

Appropriate Vt set? Appropriate rate? Appropriate I:E ratio? Consider PEEP/O2, suctioning, pneumothorax, ETT placement, P.E.

Question 25

VA = (Vt-VD) x f

Answer 25

Alveolar minute volume = (tidal volume - dead space) x rate

Question 26

Ve = Vt x f

Answer 26

Minute volume = tidal volume x rate

Question 27

Normal VD

Answer 27

Normal dead space = 1/3 Vt or 1 ml/lb IBW

Question 28

Normal Ve

Answer 28

Normal minute volume is 6.0 L/min

Question 29

Normal Vt for injury approach in ventilator management?

Answer 29

4-8 ml/kg

Question 30

To blow off CO2 increase __ first then __.

Answer 30

Volume first then rate

Question 31

To protect injured lungs on a vent, use lower __ and higher __.

Answer 31

Tidal volume | Rate

Question 32

Cheyne-Stokes respirations

Answer 32

Alternating periods of increased and decreased rate and depth with brief periods of apnea.

Question 33

Causes of Cheyne-Stokes

Answer 33

Associated with Decorticate posturing | Cushing's triad, brainstem herniation

Question 34

Biot's respirations

Answer 34

Quick, shallow, inspirations followed by apnea

Question 35

Causes of Biot's

Answer 35

Meningitis Increased ICP Damage to medulla by stroke or trauma

Question 36

Kussmaul's respirations

Answer 36

Deep and fast breathing without apnea

Question 37

Causes of Kussmaul's

Answer 37

``` Metabolic acidosis Renal failure DKA Salicylates Toxins ```

Question 38

Apneustic respirations

Answer 38

Long gasping inspiration followed by short expiration causing chest hyperinflation and hypoxia

Question 39

Causes of Apneustic respirations

Answer 39

Brain lesion | Common is decerebrate posturing

Question 40

Central Neurogenic Hyperventilation

Answer 40

Very deep, rapid respiration rate >25 bpm causing alkalosis

Question 41

Causes of central neurogenic hyperventilation

Answer 41

Increased ICP Stroke Lesion to brainstem Head injury

Question 42

Desired minute volume for an intubated patient

Answer 42

120ml/kg/min

Question 43

Desired minute volume for intubated metabolic acidosis patient

Answer 43

240ml/kg/min

Question 44

Ataxic respirations

Answer 44

Complete irregularity of breathing "A-Fib of breathing"

Question 45

Gold standard for oxygenation

Answer 45

SpO2

Question 46

Gold standard for ventilation

Answer 46

ETCO2

Question 47

#1 cause of iatrogenic death in the US

Answer 47

Ventilator Acquired Pneumonia

Question 48

Gold standard for ET tube placement

Answer 48

Chest X-Ray

Question 49

Curare Cleft on ETCO2 represents?

Answer 49

Patient needs resedated / paralyzed

Question 50

Preoxygenation is required in what patients?

Answer 50

Obese patients Pregnant patients Pediatric patients (10 lpm via NRB for 15 minutes)