Pulm Crit

Question 1

6 most common hospital-acquired conditions

Answer 1

health care-associated infections
-central line-associated bloodstream infection
-ventilator-associated PNA
-Catheter associated UTI
-C diff colitis

Skin and soft tissue pressure injuries

malnutrition

GI bleed

deliricum

NM weakness

Question 2

scale used to define risk of pressure injury

Answer 2

Braden scale

Question 3

two strong recommendations regarding SpO2

Answer 3

1- an SpO2 of 96% or lower should be maintained in pts receiving O₂ therapy

2- O₂ therapy would not be started for pts with acute MI or stroke AND an SpO2 of 93% or higher

Question 4

perfusion of lung units that are no longer ventilating 2/2 alveolar collapse, flooding with pus, edema fluid, or blood

Answer 4

Acute Hypoxemic Respiratory Failure

Question 5

how to reverse hypoxemia

Answer 5

PEEP to open flooded or collapsed alveoli

Question 6

elastic and restrictive forces that are too high, or respiratory muscles that are too weak to generate a pressure gradient causes

Answer 6

ventilatory failure

Question 7

2 methods to treat ventilatory failure

Answer 7

mechanical ventilator support:

1- noninvasive, using nasal or full mask

2- invasive, with ETT or tracheostomy

Question 8

contraindications to non-invasive ventilation

Answer 8

AMS
increased airway secretions
emesis
gastric distension
airway obstruction
recent esophageal surgery
cardiac arrest
inability to protect airway
facial trauma/surgery
pt intolerance of mask

Question 9

2 preferred sedation meds

Answer 9

propofol or dexmedetomidine are preferred over benzodiazepines

Question 10

general rule for when to consider parenteral nutrition

Answer 10

only after 7-10 days of not meeting more than 60% of energy and protein requirements by enteral route alone

or, ASAP for severely malnourished pts, at high risk of malnutrition, or when enteral is contraindicated