NBRC ARDS, CAD, Neuro

Question 1

Hypoxemic respiratory failure can be defined as a PaO2 less than ___ or a PF ratio less than ___.

Answer 1

PaO2 less than 50-60

PF ratio less than 300

Question 2

What is the most common cause of hypoxemic respiratory failure?

Answer 2

VQ mismatching

Question 3

If a patient’s FVC (Forced Vital Capacity) is less than ___, then they are in hypercapnic respiratory failure.

Answer 3

Less than 10 mg/kg

Question 4

If a patient’s MIP (Maximal Inspiratory Pressure) is less than ___, then they are in hypercapnic respiratory failure.

Answer 4

-20 cm H2O
(Remember they are inhaling. That’s why that number is expressed as -20, not 20. It’s not actually a negative number. It just indicates that they’re inhaling, not exhaling.)

Question 5

If someone’s NIF is -25, then, then -16, then -5, is their NIF getting better or getting worse?

Answer 5

It’s getting worse.

Question 6

In the ATS/ERS Criteria, a PF ratio less than 300 is ___.

A PF ratio less than 200 is ___.

Answer 6

Less than 300: Acute lung injury

Less than 200: ARDS

Question 7

What phase of ARDS is characterized by the development of lung injury and fibrosis?

Answer 7

Proliferative phase (2nd phase)

Question 8

What is the second phase of ARDS?

How long does it last?

Answer 8

The Proliferative Phase

7-21 days

Question 9

What phase of ARDS is characterized by advanced fibrosis?

Answer 9

Fibrotic phase (3rd Phase)

Question 10

You should give this class of drug to ARDS patients because of the inflammation involved in this syndrome.

Answer 10

Corticosteroids.

Question 11

What is the first phase of ARDS?

How long does it last?

Answer 11

Exudative phase

1-7 days

Question 12

What are the three I’s of a myocardial infarction?

Answer 12

Ischemia, then
Injury, then
Infarction.

Question 13

When treating an MI patient, you can give anti-ischemic therapy, including nitroglycerin, morphine, ___, and ___. (It’s not oxygen or aspirin)

Answer 13

Beta-blockers, diltiazem

Question 14

These drugs are platelet inhibitors. Aspirin, ___, ___, and ___. They’re given to MI patients.

Answer 14

Clopidogrel (Plavix)
Prasugrel (Effient)
or Ticagrelor (Brilinta)
These are platelet inhibitors.

Question 15

What is the third phase of ARDS?

How long does it last?

Answer 15

Fibrotic phase

Most patients recover in 3-4 weeks.

Question 17

When treating an MI, these drugs are good anticoagulants: Heparin, ___, and ___.

Answer 17

Fondaparinux (Arixtra) 
and Bivalirudin (Angiomax or Angiox)

Question 18

Patients who are brain dead will often have this urinary finding.

Answer 18

Increased urine output (Diabetes insipidus)

Question 19

What are the 3 prerequisites for apnea testing?

What do you do before you start apnea testing?

Answer 19

Normal BP, temp, and CO2.

Hyper-oxygenate to obtain PaO2 greater than 200.

Question 20

How do you do an apnea test? (x4)

Answer 20

1. Disconnect patient from ventiator.
2. Observe closely for breathing effort
3. Obtain an ABG after 8 minutes
4. Reconnect pt to the ventilator.

Question 21

During an apnea test, when should you re-connect the patient to the ventilator?

Answer 21

1. Systolic BP goes below 90
2. Pt desaturates
3. Cardiac arrythmias occur

Question 22

During an apnea test, you get an ABG and look at the PaCO2. What would indicate that it’s a positive test? (x2)

Answer 22

PaCO2 greater than 60 or 20 above baseline.

Question 23

How do you confirm diagnosis of brain death?

Answer 23

Cerebral Perfusion Scan. (Not EEG!)

Question 24

What is a normal Cerebral Perfusion Pressure?
Maintain CPP within what range?
A critical CPP is ___.

Answer 24

Normal is 60-100.
Maintain within 50-70.
Critical is 20-40

Question 25

There are two contraindications of ICP monitor insertion. One of them is ___, which is indicated by ___. The other is the presence of ___, especially ___.

Answer 25

Low platelet count
APTT two times normal
Immunosupressive therapy (esp. steroids)

Question 26

Brain dead patient with harvestable organs:

Keep BP above ___.

Answer 26

90

Question 27

Brain dead patient with harvestable organs:

Keep mean arterial pressure between ___.

Answer 27

60-85

Question 28

Brain dead patient with harvestable organs: Keep CVP between ___ and ___.

Answer 28

4 and 10

Question 29

What phase of ARDS will you see alveolar edema and leukocytic inflammation?

Answer 29

Exudative (1st phase)

Question 30

Brain dead patient with harvestable organs: Urine output should be between ___ and ___.

Answer 30

100-200 per hour

Question 31

What phase of ARDS will you see hyaline membranes develop?

Answer 31

Exudative (1st phase)

Question 32

What phase of ARDS is characterized by persistent dyspnea and hypoxemia?

Answer 32

Proliferative phase (2nd phase)

Question 32

What phase of ARDS is characterized by prolonged mechanical ventilation and/or supplemental O2 therapy?

Answer 32

Fibrotic Phase (3rd phase)

Question 33

Brain dead patient with harvestable organs: SpO2 should stay above ___.

Answer 33

95%

Question 34

Brain dead patient with harvestable organs: Hematocrit should be above ___.

Answer 34

30%

Question 35

Brain dead patient with harvestable organs: Temp should be between ___ and ___.

Answer 35

36.5 and 37.5
or
97.7 and 99.5

Question 36

Brain dead patient with harvestable organs: Glucose should remain at this range:

Answer 36

120-180 mg/dl

Question 37

How do you calculate CPP?

Answer 37

Cerebral Perfusion Pressure = Mean arterial pressure - ICP

Question 38

To reduce ICP, you should sedate the patient to prevent movement. What two drug classes should be used?

Answer 38

Narcotics and benzodiazepines

Question 39

What drug is used to decrease ICP?

Answer 39

Mannitol

Question 40

When should you consider surgery to treat ICP?

Answer 40

Large but focal hemorrhage
Obstructive hydrocephalus
Tumors

Question 41

How is a ischemic stroke treated? x2

Answer 41

Tissue plasminogen activator (Within 4.5 hrs)

Aspirin

Question 42

How is a cardioembolic stroke treated?

Answer 42

CT scan to see if there is hemorrhaging.
Low molecular weight heparin
Warfarin

Question 43

How do you treat TIA’s?

What are two alternatives to this drug?

Answer 43

Aspirin

If patient is aspirin sensitive, give ticlopidine or clopidogrel

Question 44

What PaCO2 constitutes hypercapnic acute respiratory failure?

Answer 44

PaCO2 greater than 50 torr and not due to metabolic alkalosis.