Air Methods Critical Care Review Airway Anesthesia and Analgesics Questions With Complete Solutions
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Air Methods Critical Care
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Air Methods Critical Care
Air Methods Critical Care Review Airway Anesthesia and Analgesics Questions With Complete Solutions
A hypoxic infant has been intubated with an uncuffed ETT. Which of the following statements indicates an appropriate understanding of mechanical ventilation as it applies to this specific patie...
A hypoxic infant has been intubated with an uncuffed ETT. Which of the following
statements indicates an appropriate understanding of mechanical ventilation as it
applies to this specific patient?
It may be difficult to maintain an appropriate mean airway pressure
Hyperventilating this patient will likely improve oxygen delivery
A fraction of inspired oxygen of 1.0 is contraindicated in this case.
PEEP should be limited to 5cmH20 with concern for oxygen toxicity - Answer-It may be
difficult to maintain an appropriate mean airway pressure
Uncuffedd ETT increases risk of not being able to maintain PEEP, and ultimately results
in decrease in mean airway pressure. Hypverventilation may cause a left shift in the
oxygen hemoglobin dissociation curve & make hemoglobin hold on "tighter" to oxygen
molecules. In turn, this would increase SpO2 but might not actually improve O2 delivery.
/.A medication used in RSI that is a depolarizing skeletal muscle relaxant would be? -
Answer-Succinylcholine
/.A patient is being mechanically ventilated with the following settings: assist control,
volume control, tidal volume 360mL, rate 17, PEEP 6cmH20.
The following parameters are assessed: mean airway pressure 15cmH20, plateau
pressure 22cmh20, AutoPEEP 3cmH20, exhaled tidal volume 380mL. What is the
driving pressure? - Answer-13
Driving pressure (delta P) is difference between PPlat and end expiratory pressure. End
expiratory pressure includes both PEEP and Auto-PEEP.
22-6 = 16 - 3 = 13
/.A patient on the mechanical ventilator at the following settings Vt 500, RR 17, PEEP 7,
FiO2 0.8, PS 10, volume control and SIMW. Has consistent plateau pressure of >35.
What ventilator change must be made?
Lower PEEP to 0
Lower pressure support to 5
Lower Vt to 450
Lower RR to 15 - Answer-Lower the Vt to 150.
,Pplat must be 30 or below. The PPlat is high because of the volume of air we are giving
per breath.
/.A patient who has been diagnosed with ARDS is being mechanically ventilated. Crew
notes SpO2 of 90% and EtCO2 of 34, PPlat 33cmH20. What is the most appropriate
initial action?
Increase PEEP to improve oxygenation
Decrease tidal volume to protect alveoli
Increase I-time to augment mean airway pressure
Decrease sedation to allow increase in frequency. - Answer-Decrease tidal volume to
protect alveoli
Increasing PEEP will likely result in increase in PPlat. PPlat should be maintained below
30cmH20. In addition, it is important to recognize oxygenation goals in ARDS may be
lower than for most patients.
/.A pediatric patient is being mechanically ventilated in SIMV with set rate of 24 breaths
per minute and measured frequency of 33 breaths per minute. Minute volume is noted
to be below goal. Which is the most appropriate action?
Increase tidal volume
Increase rise time
Increase pressure support
Increase patient trigger - Answer-Increase pressure support
An increase in tidal volume would only affect machine-delivered or time-triggered
breaths in SIMV because this pt. is initiating breaths in excess of the set rate, so this will
not have an impact on minute volume. Increasing/lengthening rise time will result in
lower tidal volumes with supported/patient-triggered breaths and further decrease
minute volume. Increasing the patient trigger will make it less likely that the patient effort
will result in supported breaths, which may result in decreased frequency and therefore
decreased minute volume. While it may be the case that patient-triggered breaths are
below goal and that facilitating the delivery of time-triggered breaths would increase
minute volume, the more direct fix is to increase pressure support to augment tidal
volume of the patient-triggered, pressure support breaths.
/.A pediatric patient that w4eighs 20kg IBW is being mechanically vented. The following
parameters are assessed:
VE: 2.1L
EtCO2: 25.
Which of the following is most appropriate interpretation of these findings?
A low EtCO2 indicates over-ventilation
This VE is appropriate for the patient
This patient needs to be resuscitated
These are normal findings in this case - Answer-The patient needs to be resuscitated.
, While a low EtCO2 may indicate over-ventilation, it can also occur when perfusion is
inadequate. VE is 101ml/kg, which is below goal for pediatric patients and indicates
underventilation or hypoventilation
/.A pregnant patient is being ventilated and it is noted that the EtCO2 is 30mmHg.
Which statement is appropriate?
The EtCO2 may, in fact, be a normal finding
An abnormal EtCO2 can be caused by positioning
This might be related to decreaesed physiologic need
This warrants an increase in minute volume - Answer-This EtCO2 may, in fact, be a
ormal finding.
Increased ventilatory support is needed during pregnancy and leards to a lower PCO2
and EtCO2. An Abnormal EtCO2 can be caused by positioning of the patient. Elevating
HOB 30-35 degrees is needed along with tilting the pelvis 15 degrees to the left or right.
/.A pregnant patient is being ventilated in volume control ventilation and a high-pressure
alarm is noted. Subsequent breaths do not trigger the alarm but peak pressure remains
high. Which of the folllowing is an appropriate response?
Switch from volume control to pressure control
Assess plateau pressure to consider possible causes
Reposition patient into a supine position
Silence and clear the alarm, then increase the limit - Answer-Assess plateau pressure
to consider possible causes
The correct initial action is to assess plateau pressure first. Switching from volume
control to pressure control could result in inadequate minute volume.
/.Acronym to consider for surgical cric considerations - Answer-SMART
Surgery of Neck
Mass
Access to the neck - obesity, Limited ROM
Radiation
Tumor
/.Acronym to consider when predicting a difficult airway - Answer-HEAVEN
Hypoxemia
Extremes of size - obese pt, petite pt.
Anatomic disruption/obstruction
Vomit/blood/fluid
Exsanguination- bled out so much they can't keep SpO2 up
Neck mobility/neuro injury
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