Pulmonary Critical Care

Question 1

How is respiratory failure defined?

Answer 1

Occurs when lungs fail to oxygenate the arterial blood accurately and/or fail to prevent CO2 retention

Question 2

What is type I respiratory failure?

Answer 2

Hypoventilation

Question 3

What is minute ventilation?

Answer 3

Can lead to both low PAO2 and high PCO2 d/t decreased total volume of inhaled/exhaled air per minute

Question 4

What is the average minute ventilation for an adult?

Answer 4

8 L/min

Question 5

What are the causes of hypoxemia due to low FIO2?

Answer 5

High altitude
Smoke inhalation
Hypoventilation (CNS depression)
COPD

Question 6

How can you assess oxygenation?

Answer 6

• Assessed by the PaO2
• Arterial blood gas analysis
• Estimated oxygen status with pulse oximetry
• A-a gradient
• PF ratio
• CXR

Question 7

How is PF ratio measured?

Answer 7

PaO2/FiO2

Question 8

When is PF ratio used?

Answer 8

Value used in definition of ARDS

Question 9

What is a normal PF ratio?

Answer 9

> 400

Question 10

Where are the respiratory center located?

Answer 10

Medulla Oblongata

Question 11

For every Liter of oxygen added how much are you increasing the patient’s FiO2?

Answer 11

3-4% per L

Question 12

What are some direct pulmonary causes of ARDS?

Answer 12

• Chest trauma/lung contusion
• Acid suppression
• pneumonia

Question 13

What are the clinical manifestations of ARDS?

Answer 13

• Significant respiratory distress
• Dyspnea
• Tachypnea
• Hallmark is hypoxia despite significant FiO2

Question 14

What is a typical way to describe a CXR in a patient with ARDS?

Answer 14

Complete whiteout

Question 15

What is essential in managing ARDS?

Answer 15

Identify/treat underlying or predisposing cause of ARDS (Golden Hour mentality- abx or other treatment ASAP)

Question 16

What is a critical ventilator management for ARDS?

Answer 16

Lung Protection Strategy to prevent barotrauma

The two main aspects of protective mechanical ventilation are to limit tidal volume (VT) and plateau pressures to prevent lung damage caused by overdistension and to set PEEP level to minimize the cyclic opening and closing of airways and lung units

Question 17

An increased PEEP can have what effect on intracranial pressure?

Answer 17

Increased ICP

Question 18

What is the most common symptom in foreign airway obstruction?

Answer 18

Cough