You are at the bedside of an oscillated patient when they become disconnected from the circuit. The oscillations have stopped and the vent is alarming. The steps you would take to resume oscillations would be: 1. reconnect patient, depress the start/stop button 2. depress the start/stop button, reconnect patient, press and hold the power fail/reset button 3. reconnect patient, press and hold the power fail/reset button, depress start/stop button 4. reconnect patient, depress the power fail/reset button

3. reconnect patient, press and hold the power fail/reset button, depress start/stop button

Review Questions Flashcards by Megan Lesinszki

On the Sensormedics 3100B the distance the piston travels determines:

a. The frequency
b. The amplitude
c. The mean airway pressure
d. All of the above

b.The amplitude

The frequency will be determined by how fast the piston is moving as it is the RR, which is determine and set with Hertz (RRx60). The mean airway pressure will be set and is held constant.

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You are ventilating a patient on the Sensormedics 3100B. The control that determines the FRC of a patient is:

a. Amplitude
b. Frequency
c. Mean airway pressure
d. Ti%

c.Mean Airway Pressure

You amplitude in a way is like you tidal volume but as it is the area under the curve it will also be affected by frequency. However tidal volumes in HFV are so small that the lung are practically unmoving which is why amplitude and frequency will not affect the FRC. What does determine the FRC is mean airway pressure which is the pressure that is held in the lung constantly in order to keep them open.

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Frequceny and Vt Relationship

Inverse

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Frequency and Alkalosis

To deal with alkalosis you should increase frequency

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Respiratory Alkalosis Management

When you are in respiratory alkalosis you want increase CO2, and by increasing frequency you are decreasing tidal volume and increasing what is considered the RR. Be increasing the RR you are spending less time in exhalation so you are holding onto more CO2.

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You are ventilating your patient on the Sensormedics 3100B. Their recent ABG shows an acute respiratory alkalosis. Which of the following changes would most likely return the ABG to normal values:

a. Increase Ti%
b. Increase frequency
c. Increase MAP
d. Increase the bias flow

b. Increase frequency

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When the adjustable MAP alarm (ie. The one set by the operator) is activated on the Sensormedics 3100B, the following occurs:

a. AV alarm
b. Bias flow stops
c. Oscillations cease
d. Dump valve opens
e. All of the above

a.AV alarm

When the alarm sound no changes will be made automatically by the ventilator rather you have to insect the machine and see what is happening.

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You are at the bedside of an oscillated patient when they become disconnected from the circuit. The oscillations have stopped and the vent is alarming. The steps you would take to resume oscillations would be:

reconnect patient, depress the start/stop button
depress the start/stop button, reconnect patient, press and hold the power fail/reset button
reconnect patient, press and hold the power fail/reset button, depress start/stop button
reconnect patient, depress the power fail/reset button

reconnect patient, press and hold the power fail/reset button, depress start/stop button

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PPHN and Oxygenation

You want to give high oxygen to these babies

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You are ventilating the patient using a NPB 7200 with the following settings. What is the approximate size of the spontaneous breath?

Mode: SIMV(VC)+PS

Set RR: 8

Vt: 550 mL

Plateau: 0.5 sec

PS: 10 cmH2O

PEEP: 8 cmH2O

FiO2: 0.60

Measured RR: 22

Measure MV: 8.9

PIP: 28 cmH2O (Mechanical Breaths)

First solve for the set minute ventilation

Set Minute Ventilation= 8 x 0.55

Set Minute Ventilation= 4.4

Next subtract the set minute ventilation from the measured minute ventilation

8.9-4.4=4.5

Finally solve for tidal volume with the minute ventilation equation

4.5=(22-8) x Spontaneous Vt

Spontaneous Vt=321 mL

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Which of the following statement is/are correct in regards to APRV/BiLevel

a. When set up it is similar to inverse ratio pressure control
b. Meant to be used on sedated comatose patient
c. Breathing on two CPAP levels
d. All of the above
e. A and C

a.A and C

What you are setting is essentially pressure control on a high CPAP level with a low pressure release time. This is setting up a long inspiration and short expiration with an inverse ratio of 4:!. To get the most benefit out of APRV you will want to use it where the patient is able to breath spontaneously (not sedated and comatose.

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During ASV ventilation which of the following is true

a. This mode is designed for partial ventilatory support only
b. A setting of 120% minute volume would mean that the ventilator would deliver and 8.4 LPM for a 70 kg patient
c. A patient with a minute volume percent setting of 80%; has 100% spontaneous breathing receiving a Pinsp of 5, FiO2 0.35, PEEP 5, Frequency of 18, Vt of 400mL, Should be considered for ventilator disconnection
d. All of the above
e. B and C

e.B and C

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Which of the following mode is appropriate for a comatose patient?

I. ASV

II. CMV PC

III. SIMV APV

IV. PSV

V. Volume Support

I, II, III, V

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Which of the following is the true statement in regards to PAV+

PAV+ is based on the equation Pmus = Palveolar + Ptransairway

The breath delivered is a constant set pressure

PAV+ is indicated for neuromuscular patient

PAV+ can be used when there are leaks in the circuit

PAV+ is based on the equation Pmus = Palveolar + Ptransairway

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Which of the following is an acceptable method of SBT?

a. SIMV with low respiratory rate, CPAP of 5 cmH2O, and pressure support of 5 cmH2O
b. PEEP of 5 cmH2O and pressure support of 5 cmH2O
c. Volume support, CPAP of 5 and Vt target of 8ml/kg
d. CPAP of 5 cmH2O and tube compensation
e. B and C

B and C

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Which of the follow is a goal of ventilation for a patient with pulmonary edema

Decreased workload of the heart

Decreased hypoxemia

Decrease circulating volume

All of the above

.A and B

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Which of the following is the most appropriate ventilator strategy for a paralyzed and sedated patient with a closed head injury?

Hyperventilate the patient

Keep PaCO2 between 35-45 and SpO2 88-92%

Keep PaCO2 between 35-40 mmHg and well oxygenation

Permissive hypercapnia strategy

Keep PaCO2 between 35-40 mmHg and well oxygenation

We only hyperventilate the patient as a short term treatment to decrease ICP. You want to keep this patient population well oxygenated (PaO2 80-120 mmHg). We are more focused on keeping the patient well oxygenated than we are focused on permissive hypercapnia.

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Which of the following is not a goal of NPPV in the acute care setting

Avoid intubation

Decreased incidence of VAP

Decrease length of stay

.Improve mobility

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You are ventilating a 75 kg patient in CMV (VC) with the following settings

Vt Set: 600 mL

RR Set: 12 bpm

PEEP 5 cmH2O

Flow 80 LPM with a decelerating flow pattern

FiO2 0.4

Measured values include:

PIP 28 cmH2O

RR 20 bpm

ABG: Acute Respiratory Alkalosis with corrected hypoxemia.

What would be the appropriate ventilator changes?

Decreasing RR

Switching to SIMV or CSV with pressure support

Increasing PEEP

Increasing the set Vt

Switching to SIMV or CSV with pressure support

Which of the following will affect patient ventilator synchrony

Sensitivity level

Set flow rate

Auto PEEP

All of the above

Given the following ABG while on NPPV, what change is recommended

32, 55, 75, 28, +3, 95%
a. Increase FiO2 and increase CPAP
b. Increase EPAP and increase FiO2
c. Increase IPAP
d. Increase CPAP

C. Increase IPAP

Your patient is being non-invasively ventilated in a S/T mode of a non-invasive ventilator. Which of the following is true

Patient triggered breath are flow cycled

Both patient and time triggered breaths are flow cycled

Mandatory breaths are always given at the set rate

Patient triggered breaths are time cycled

Patient triggered breath are flow cycled

A 36 week gestation infant has the following assessment. Which of the following is the best action

RR at 79 with subcostal/intercostal indrawing

FiO2 50% per the head box

CXR shows increased interstitial markings, fluid in the horizontal fissure

CBG: 7.32, 50, 45, 25, -1, 75%

Initiate CPAP at 6 cmH2O

Intubate and place on mechanical ventilator

Increase FiO2 to 60%

Give 5 mg of Lasix

Initiate CPAP at 6 cmH2O

Which of the following best describes proper initial ventilator alarm set up? Patient is 60kgs.

a) High minute volume (MV) alarm set 2 LPM higher than expected. Low MV alarm set 2 LPM lower than expected. High pressure alarm set at 55 cmH2O.
b) High pressure set at 40 cmH2O. Apnea time of 20 seconds. Low inspiratory pressure at 5 cmH2O below PEEP.
c) Apnea parameters set for partial ventilatory support.
d) High MV of 8 LPM, Low minute volume of 4 LPM. VTI of 800 mls.

d) High MV of 8 LPM, Low minute volume of 4 LPM. VTI of 800 mls.

Which of the following is the best choice for initial ventilator settings for full ventilatory support of an adult male who is 5 feet 8 inches tall? a) CMV VC, frequency 14, Vt 550 mls, Flow 60 LPM decelerating wave, PEEP 5 b) CMV PC, frequency 17, PIP 22 cmH2O, PEEP 7 c) CPAP 5 cmH2O, pressure support of 10 cmH2O d) SIMV APV, frequency 8, Vt 550 mls, PEEP 5

a) CMV VC, frequency 14, Vt 550 mls, Flow 60 LPM decelerating wave, PEEP 5

According to the equation of motion of the respiratory system, a ventilator can control all of the following variables except: a) Volume b) Resistance c) Pressure d) Flow

b) Resistance

All of the following are hazards associated with mechanical ventilation except: a) Reduced cardiac output b) Liver failure c) Increased work of breathing d) Acute lung injury

b) Liver failure

You are ventilating a patient in CMV APV. The latest ABG results are: 7.34, 50, 55, 26, 0, 89%. Which of the following changes will improve oxygenation? a) Increase ramp time b) Decrease Ti c) Increase PEEP d) Increase FiO2 e) c and d

e) c and d

You are ventilating a patient in ACVC; latest ABG shows: 7.29, 55, 81, 26, -1, 96%. Which of the following will improve oxygenation? a) Switch from a square to decorating waveform b) Increase resp rate c) Increase Vt d) Increase flow-rate e) b and c

e) b and c

Which of the following indicate the need for ventilator support of a 62 kg patient? a) MIP – 18 cmH2O b) Spontaneous Vt of 300 ml c) Vital capacity of 990 ml d) P/F 375 e) All of the above

a) MIP – 18 cmH2O

For which of the following uses might you consider the use of a purely pneumatically powered ventilator? I. As a backup to electrically powered ventilators II. When electrical device cannot be used (MRI) III. During certain types of transport

I, II, III

The first step for basic life support when an unconscious adult is found is? Assess the pulse Assess breathing Early defibrillation Early chest compressions

Assess breathing

The correct ratio for chest compressions and respirations when an advanced airway is in place for an adult patient is? 30 Compression : 2 Respirations 15 Compressions: 2 Respirations Continuous Compressions: 8-10 Respirations/min Continuous Compressions: 12-20 Respirations/min

Continuous Compressions: 12-20 Respirations/min

Which of the following indicates appropriate chest compression for an adult? Rate ≥ 100/min and PETCO2 \> 10mmHg Depth of ≥ 1 inch Allow complete recoil All of the above A and C

A and C

Which of the following may be appropriate for an adult cardiac arrest in VF/VT I. CPR II. Defibrillation III. 3-5 mg of Epinephrine IV. 300 mg of amiodarone

I, II, IV

Which of the following may be appropriate for an adult cardiac arrest in asystole/PEA I. CPR II. 1 mg of Epinephrine III. 1 mg of Atropine IV. 150 mg of Amiodarone

I, II

Which of the following may be appropriate for an unstable adult bradycardia with a pulse I. Atropine 0.5 mg II. Dobutamine 2 mcg/kg/min III. Epinephrine 2 mcg/kg/min IV. Transcutaneous Pacing

I, III, IV

Which of the following may be appropriate for an unstable adult tachycardia with a pulse? I. Atropine 0.5 mg II. Synchronized Cardioversion III. Adenosine 6 mg IV. Epinephrine 1 mg

II, III

Which of the following is a correct as an indication for epinephrine in a newborn resuscitation? Heart Rate of 45/min Heart Rate of 75/min Heart rate of 50/min after 30 seconds of effective ventilation and 30 seconds of chest compressions Unresponsive to resuscitation and known maternal blood loss

Heart rate of 50/min after 30 seconds of effective ventilation and 30 seconds of chest compressions

Which of the following actions are appropriate for Robin Syndrome baby I. Oral Intubation II. LMA III. NPA IV. Placed in Prone Position

All of the Above

Which of the following action is the most important and effective step in neonatal resuscitation? a. Ventilation of the lungs b. Epinephrine c. Chest Compression d. Tactile Stimulation

a. Ventilation of the lungs

You assess a 5-year-old who is unresponsive, with no pulse and no breathing, on the pediatric ward. Which is the next appropriate step a. Call a code and start ventilation b. Call a code 66 and start ventilation c. Call a code and start compression d. Apply a non rebreathe mask

c. Call a code and start compression

A child is placed on a monitor/defibrillator; the child is unconscious, with no pulse and rhythm is VT. Which of the following is the correct action? a. Apply a non rebreathe mask b. Immediate cardioversion c. Give amiodarone d. Defibrillate

d. Defibrillate

Which of the follow is an appropriate management for cardiogenic or non-cardiogenic pulmonary edema in pediatric patients with respiratory distress I. Salbutamol II. NPPV III. Diuretic IV. Vasoactive Drug

II, III, IV

Which of the following is indicated for pediatric respiratory distress caused from anaphylaxis? I. Oxygen II. Salbutamol III. Epinephrine IV. Antibotics

I, II, III