GENERAL CRITICAL CARE -ACCS EXAM, LATEST TEST 2023/2024

GENERAL CRITICAL CARE -ACCS EXAM, LATEST TEST 2023/2024 What is the thyromental distance? - CORRECT ANSWER-Measurement of the distance between the upper edge of the thyroid cartilage to the chin, while the neck is completely extended. Thyromental distance: what indicates a suspected difficult intubation? - CORRECT ANSWER-Less than 6 cm Thyromental distance: what suggests a non-problematic intubation? - CORRECT ANSWER-7 cm or greater What type of x-ray should you use to determine proper position of an endotracheal tube? - CORRECT ANSWER-AP x-ray What type of x-ray is helpful in detecting pleural effusions? - CORRECT ANSWERLateral decubitus The description "concave superior border or interface" describes what? - CORRECT ANSWER-A pleural effusion What type of x-ray is helpful and spotting internal issues such as masses, blebs, or lesions? - CORRECT ANSWER-Oblique x-ray On x-ray, where should the end of the endotracheal tube be positioned? - CORRECT ANSWER-2-5 cm above the carina On x-ray, where should the central venous catheter be positioned? - CORRECT ANSWER-The tip should rest in the right atrium or vena cava On x-ray, where should the pulmonary artery catheter be positioned? - CORRECT ANSWER-The tip should be over the right lower lung field What type of diagnostic imaging is used to detect the functionality of organs? - CORRECT ANSWER-PET scan What is the gas the patient breathes during a V/Q scan? - CORRECT ANSWER-Xenon On V/Q scan, what do dark areas of the lungs indicate? - CORRECT ANSWERAbsence of ventilation in that area On V/Q scan, the description "wedge shaped" indicates what? - CORRECT ANSWER-A clot What is considered normal work of breathing? - CORRECT ANSWER-0.5-0.7 J/L Three key criteria for brain death - CORRECT ANSWER-1. Unresponsiveness 2. Absence of reflexes 3. Presence of apnea Normal stroke volume - CORRECT ANSWER-50-100 mL Normal ejection fraction - CORRECT ANSWER-50-70% The best lead to determine the left ventricle status - CORRECT ANSWER-V5 The best lead to determine overall electrical condition of the heart - CORRECT ANSWER-Lead II Hypertrophy will cause an axis deviation in what direction? - CORRECT ANSWER-In the direction of the hypertrophy, usually to the left, as in CHF If tissues are infarcted or dead, the axis will deviate where? - CORRECT ANSWERAway from the infarcted tissue Myocardial ischemia is what? - CORRECT ANSWER-A current lack of oxygen to the cardiac muscle. Myocardial ischemia shows as what on an EKG? - CORRECT ANSWER-Flipped T waves Myocardial injury is what? - CORRECT ANSWER-Cardiac tissue currently dying How does Myocardial injury present on EKG? - CORRECT ANSWER-Elevated ST segments Myocardial infarction is what? - CORRECT ANSWER-Dead cardiac tissue, old or fresh How does myocardial infarction present on EKG? - CORRECT ANSWER-Profound Q waves Normal CVP range - CORRECT ANSWER-2-6 mmHg Normal PAP - CORRECT ANSWER-25/8 mmHg or 14 Normal PCWP (pulmonary capillary wedge pressure) - CORRECT ANSWER-4-12 mmHg or 8 mmHg Where is the best place to get a mixed venous sample? - CORRECT ANSWER-PAP Normal cardiac output - CORRECT ANSWER-4-8 L/min Normal MAP range - CORRECT ANSWER-85-100 mmHg What is the most common complication of PA catheter insertion? - CORRECT ANSWER-Cardiac arrhythmias Once the PA catheter is in the right atrium, what is the next? - CORRECT ANSWERThe balloon is inflated and the catheter flows into the pulmonary artery where the balloon is deflated What is the dicrotic notch indicative of? - CORRECT ANSWER-It represents the closure of the pulmonic valve If the dicrotic notch is not present, the situation is called what? - CORRECT ANSWERPressure dampening What does pressure dampening indicate? - CORRECT ANSWER-A possible obstruction to the PA catheter Four steps that should be taken to resolve pressure dampening - CORRECT ANSWER1. Check transducer dome for air bubbles 2. Aspirate - to remove a potential clot 3. Flush the catheter 4. Rotate the catheter It is very important to not _____ or _____ the catheter to address pressure dampening - CORRECT ANSWER-Advance, Withdrawal Where specifically should you draw a mixed venous sample? - CORRECT ANSWERDistal lumen ____ Is the initial action for shock - CORRECT ANSWER-Fluid administration A pH of what indicates respiratory failure? - CORRECT ANSWER-7.25 If a patient is given this drug and feels better, the patient is positive for myasthenia gravis - CORRECT ANSWER-Tensilon (edrophonium) If a patient crashes after Tensilon administration, this is called what? - CORRECT ANSWER-Anti-cholinergic crisis An anti-cholinergic crisis should be treated with what? - CORRECT ANSWER-Atropine