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FCCS COMPLETE QUESTIONS AND VERIFIED ANSWERS EXAM 2024 UPDATE GRADE A+
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FCCS COMPLETE QUESTIONS AND VERIFIED ANSWERS EXAM 2024 UPDATE GRADE A+
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FCCS COMPLETE QUESTIONS AND VERIFIED ANSWERSEXAM 2024 UPDATE GRADE A+
What intervention improves outcomes with ROSC after cardiac arrest?
Targeted temperature management.
Which type of respiratory failure occurs with CNS depression after an OD?
Acute hypercapnic respiratory failure --> mixed
What is the most important sign in a critically ill pt? Why?
Tachypnea
Indicates metabolic acidosis (often 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?
Cardiac tamponade; obstructive shock
If a pt has a thyromental distance of 2 cm, what can you expect about their
airway?
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?
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?
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?
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?
The pt is having apneic episodes, which means that administering high-flow O2 will be
ineffective.
,Choose an LMA if the BVM fails.
32-36 C
A shunt means there is perfusion without ventilation. What disease process is an
example of a shunt?
Pneumonia
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?
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?
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?
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 time to exhale and making sure he has enough flow. FiO2 is at .50. He is
sedated and seems comfortable. On ABG the pH is 7.24, CO2 is 65, O2 is 80, and
bicarb is 29.
What would you do with the vent settings in this case?
,Keep the settings where they are.
You can't hyperventilate the pt to blow off CO2 b/c the asthma will worsen. As long as
the pH is > 7.2, the settings are okay as they are. CO2 will correct over time.
Which two conditions are the most indicated for BiPAP?
COPD exacerbation
Cardiogenic pulmonary edema
A 70 y/o pt with CHF presents with SOB, accessory muscle use, RR 34, SpO2 90%
on 8L O2. CXR reveals infiltrates in a bat wing pattern. She also has LE edema.
She is dx with a CHF exacerbation w/ respiratory failure. Her ABG shows pH 7.3,
PO2 64, CO2 50.
What is the best tx for this pt?
Non-invasive BiPAP.
A pt comes in w/ a femur fx and a rod is placed. Post-op he develops dyspnea
and fever. HR 140, RR 30, SpO2 92% on non-rebreather. He is transferred to the
ICU where you intubate, place a central line, and start resuscitating him. Hb 8.2,
lactate 3.2, SVO2 is 52%.
Why is his SVO2 low? How can we improve it?
Decreased O2 delivery and increased consumption.
(normal is 65-70)
Administer packed RBCs - 1U of blood will change his Hb from 8.2 to 9.2. O2, fluid, and
VT would not work.
A young pt after an MVA comes to the ER hypotensive and tachycardic. CXR is
clear. He has a contusion on his chest wall and torso. He is unconscious. What
will give you the best insight on what is causing his shock?
Hb
SCV
Urine Output
FAST exam
FAST exam
41 y/o pt in the SICU following debridement of b/l lower extremities for necrotizing
fasciitis is intubated on AC. Temp 102, HR 116, RR 16, BP 92/46. ABG shows pH
7.23, PO2 133, PCO2 38, Na 139, K 3.7, Cl 102, Bicarb 16, lactate 4. Dx is metabolic
acidosis w/ anion gap d/t infection.
What is the most appropriate intervention?
Increase VT
Continue resuscitation
, Decrease RR
Administer bicarb
Continue resuscitation. Don't need to increase VT bc the pt doesn't have respiratory
acidosis. If you decrease the RR, the pt will go into respiratory acidosis.
A pt has obstructive uropathy. A catheter is placed d/t the obstructive kidney
injury. After the cath is placed, he has massive diuresis to the point where he is
hypotensive, tachy, and lactate is 2x the ULN from decreased perfusion.
How would you correct this?
Fluids - LR
When treating hyponatremia, what is the first thing to assess?
When do you give 3% NaCl?
How do you correct it?
1. fluid status
2. seizures or changes in mental status
3. slowly, 8-12 meq over 24 hr
What are the classifications of hemorrhagic shock?
I: <15%; HR <100, BP normal, RR normal
II: 15-30%; HR >100, BP normal, RR 20-30
III: 30-40%; HR >120, BP low, RR 30-40
IV: >40%; HR >140, BP low, RR >40
An 84 y/o pt fell down the stairs. He is moaning and crying. He has a C-collar in
place. His neck is painful and he has bruising on his face. He is tachy but BP is
okay. You administer 2L O2 bc SpO2 was 92%. Shortly after he deteriorates,
becoming altered and then comatose. His left pupil > the right. He is herniating
from cerebral edema.
How do you treat him?
Intubate and ventilate, maintaining c-spine precautions. Administer mannitol.
A pt comes in with several cardiovascular RFs: elderly, DM, and HTN. He is
having chest pain, SOB, and is diaphoretic. What diagnosis do you need to re-
perfuse him immediately?
STEMI
What is the most appropriate management for both STEMI and non-STEMI?
nitro if bp >80
morphine q 30 min
bb
oxygen if sats are <94%
Oxygen
Which NSTEMI needs to be sent to the cath lab immediately?
NSTEMI w/ shock
Which medication improves outcomes for pts with STEMI?
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