ICU

Question 1

hypoxia

Answer 1

decreased O2 delivery to TISSUE

Question 2

hypoxemia

Answer 2

decreased arterial oxygen tension

Question 3

MC causes of dypsena

Answer 3

obstructive dz
PNA
ischemia 
psychogenic 
CHF

Question 4

LIFE threatening cause of dypsnea

Answer 4

upper airway obstruction 
PE 
tension PTX
Fat emboli 
muscle neurogenic (MG, GB, botulism)

Question 5

mild respiratory distress

Answer 5

sentences
22 RR
NML consciousness

Question 6

moderate respiratory

Answer 6

23-28 RR

3-5 word sentences

Question 7

severe respiratory distress

Answer 7

> 28 RR
0-1 words
AMS/Fatigue

Question 8

mechanism of hypoxia

Answer 8

decreased O2 saturation
decreased cardiac output
decreased hemoglobin

Question 9

mechanisms of hypoxemia

Answer 9

R to L shunt
hypoventilation 
decreased diffusion 
low O2 intake 
VQ mismatch

Question 10

R to L shunt

Answer 10

blood skipping pulmonary circuit oxygenation before going to tissue

WILL NOT IMPROVE WITH OXYGENATION

Question 11

body response to hypoxemia

Answer 11

increased minute ventilation

sympathetic response (Increased HR, CO)

pulmonary vasoconstriction

Question 12

diagnosis of hypoxemia

Answer 12

ABG PaO2 < 60

Question 13

hypercapnia

Answer 13

caused by HYPOVENTILATION

PaCO2 > 45

Question 14

etiologies of hypercapnia

Answer 14

1. decreased respiratory drive
2. decreased tidal volumes
3. rapid shallow breathing

Question 15

Alveolar volume =

Answer 15

Tidal Volume - Dead space

Question 16

alveolar hypoventilation via:

Answer 16

decreased respiration
decreased tidal volume
increased dead space

Question 17

DDX of hHypercapnia

Answer 17

decreased central respiratory drive (brainstem lesion, opioids/sedatives, tetanus)

thoracic cage disorder

neuromuscular impairment (organophosphate)

COPD

Question 18

actue hypercapnia s/ s

Answer 18

raises ICP = vasodilation

HA, dyspnea, confusion

peropejra; ams cpmkimctova; ju[ere,oa

Question 19

chronic hypercapnia ABG

Answer 19

this state is actually tolerated, pts adjust

Bicarb >28
PCO2 >45
Normal pH

Question 20

diagnosis of hypercapnia

Answer 20

ABG

Chronic: large bicarb compensation (kidney)

Acute: mild elevation in bicarb bc kidney can’t keep up

Question 21

tx hypercapnia

Answer 21

increased minute ventilation via BiPap/CPAP

Question 22

central cyanosis

Answer 22

tongue + mucous membranes

inadequate pulmonary oxygen or abnormal HgB

via hypoxemia, VQ mismatch, RL shunt, HgB abnormalities

Question 23

peripheral cyanosis

Answer 23

extremities and digits

vasoconstriction/diminished peripheral flow

via decreased CO, cold extremities, shock

Question 24

dx and tx cyanosis

Answer 24

ABG

supplemental oxygen

Question 25

criteria for diagnosing ARDS

Answer 25

1. new bilateral infiltrates 2. respiratory failure not explained by HF/volume 3. impaired oxygenation

Question 26

pathogenesis ARDS

Answer 26

interstitial and alveolar pulmonary edema , alveolar collapse, hypoxemia

Question 27

respiratory failure

Answer 27

abnormalities of oxygenation or ventilation pulmonary and non pulmonary

Question 28

s/s of respiratory failure

Answer 28

hypoxia and hypercapnia high decree of suspicion + ABGs

Question 29

indications for mechanical vent

Answer 29

1. hypoxemia 2. upper airway obstruction 3. impaired airway protection 4. inability to clear secretion 5. respiratory acidosis 6. progressive fatigue, tachympna AMS' 7. Apnea

Question 30

modes of mechanical vent

Answer 30

1. controlled mechanical vent (VC/PC) 2. SIMV 3. Pressure support 4. T piece

Question 31

tidal volume based on

Answer 31

IDEAL body weight (5-7 L/kg)

Question 32

respiratory failure and mechanical vent

Answer 32

Lung protective ventilation (lower tidal volume)

Question 33

postivie pressure ventilation

Answer 33

decreased diastolic filling and increases output during systole REDUCES ventricular filling therefore preload and afaterload changes

Question 34

assisted control

Answer 34

volume and flow rate OR pressure and I:e ratio

Question 35

PEEP

Answer 35

ventilation setting keeps small airway open to reduce damage to alveolar

Question 36

peak airway pressures should be less than

Answer 36

35

Question 37

CMV

Answer 37

continuously pumps air in despite patient effort not common

Question 38

assist control MOA

Answer 38

vent delivers MINIMUM number of supported breathes pt breath triggers fully assisted vent reacts but machine will breath if pt doesn't

Question 39

SIMV

Answer 39

combined ventilation with spontaneous breathing limits breath when pt is exhaling but delivered minimum number completely turns off it pf breathes

Question 40

airway devices steps

Answer 40

pressure control/bipap (awake, can trigger breath) - NO SET RATE SIMV v (assisted, coincides with inspiratory) AC (pt trigger or machine trigger, BREATHES for pt)

Question 41

general supportive care ventilation

Answer 41

decreased potassium decreased phosphate sedatives/hypnotics analgesics

Question 42

mechanical vent complications

Answer 42

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