What is the most important sign in a critically ill pt? Why? - ANSWER-Tachypnea
Indicates metabolic acidosis w/ respiratory alkalosis compensation
A pt misses dialysis for a few days and comes in with fluid overload. He's tachycardic and tachypneic. On physical exam, you find JVD, pulsus para...
what is the most important sign in a critically ill pt why
a pt misses dialysis for a few days and comes in with fluid overload hes tachycar
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FCCS Review 2023 Questions with correct Answers
What is the most important sign in a critically ill pt? Why? - ANSWER-Tachypnea
Indicates metabolic acidosis w/ respiratory alkalosis compensation
A pt misses dialysis for a few days and comes in with fluid overload. He's tachycardic and tachypneic. On physical exam, you find JVD, pulsus paradoxus (20 mmHg drop during inspiration), and HoTN (80/40) with distant, muffled heart sounds. Lungs are clear to auscultation. What is the dx? - ANSWER-Cardiac tamponade; obstructive shock
If a pt has a thyromental distance of 2 cm, what can you expect about their airway? - ANSWER-Difficult airway w/ an anteriorly displaced larynx
A COPD pt comes in with difficulty breathing. He then becomes apneic and unresponsive. How would you ventilate this pt? - ANSWER-BVM
A pt arrives after falling from a ladder and has a frontal laceration. On examination, you find papilledema and labored breathing w/o being able to clear secretions. What is your biggest concern when intubating this pt? - ANSWER-Cerebral edema/increasing ICP
Intubation tends to cause an increase in ICP. Administer lidocaine prior to intubation to inhibit vagal stimulation.
An ESRD pt w/ hyperkalemia develops dyspnea and requires intubation. Which paralytic agent/NMB should you avoid and why? - ANSWER-Succinylcholine
Worsens hyperkalemia
A pt is admitted after an OD. He starts to have apneic episodes and his SpO2 is dropping. You place him on a non-rebreather mask w/ 100% O2, yet his SpO2 remains at 80%. Why is it not being corrected?
Then, if you try a BVM and it also fails, and video laryngoscopy is unavailable, what is your next best choice for an airway? - ANSWER-The pt is having apneic episodes, which means that administering high-flow O2 will be ineffective.
Choose an LMA if the BVM fails. What intervention improves outcomes with ROSC after cardiac arrest? - ANSWER-
Targeted temperature management.
32-36 C
A shunt means there is perfusion without ventilation. What disease process is an example of a shunt? - ANSWER-Pneumonia
Which type of respiratory failure occurs with CNS depression after an OD? - ANSWER-
Acute hypercapnic respiratory failure --> mixed
A 50 y/o pt is having a COPD exacerbation. You have tried steroids, bronchodilators, etc. with no improvement. PCO2 is in the 90s, pH is 7.20. You decide to intubate. Vent settings are: VT 375, RR 20, FiO2 .35, PEEP 5. CXR is normal. A few minutes later, his BP drops to 70/40. Lungs are clear/equal. Vent shows peak airway pressure of 55 (high) and plateau pressure of 15. End expiratory hold gives auto-peep of 15. What is the cause of this pt's HoTN and why? - ANSWER-Auto-peep is the cause.
COPD pts have difficulty exhaling --> pressure buildup in alveoli.
We use PEEP for the pressure and to improve oxygenation. Auto-peep comes from breath-stacking --> intrinsic peep. Alveoli enlarge --> high peak airway pressure. All leads to low venous return --> low CO --> HoTN
A COPD pt is admitted to the ICU for exacerbation. Pt is on a vent. Pt is tx w/ bronchodilators, steroids, and Abx. ABG was normal 1 hr ago, but now the peak airway pressure is up to 55 and plateau pressure is also high at 50. Pt becomes hypotensive at
70/40. You observe tracheal deviation to the R. Normal breath sounds on the right, diminished on the left. No wheezing. WBC is normal.
What is the dx and treatment? - ANSWER-Tension pneumothorax
Needle decompression/chest tube
A pt in ARDS s/p pneumonia is on 100% FiO2 with PEEP of 22. PO2 is 88%. Peak airway pressure and plateau are both high. VT is 5 ml/kg.
How can you decrease the airway pressures? - ANSWER-Decrease the PEEP, even though it will decrease PaO2.
(Note: you can't decrease the VT because it is already on the low end).
A young asthmatic pt is on the vent. His lungs are very tight. He is on the AC setting and there is a lot of auto-PEEP. You correct it by reducing the rate, giving him more
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