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Question 1

CCP staged approach to refractory hypoxemia

Answer 1

1. Increase FiO2 to 1.0 (increased diffusion gradient)
2. Optimize PEEP (increased mean airway pressure)
3. Increase RR (increased mean airway pressure)
4. Increase tidal volume
5. paralyze
6. Switch to pressure control mode
7. Increase Ti time (draw out your inspiratory time)
8. Recruitment manoever
9. Prone patient
10. ECMO

Question 2

core principles of mechanical ventilation in asthmatics

Answer 2

1.80% matching of autopeep
2. keep the respiratory rate low (to allow increased time for exhalation). don’t worry about matching their intrinsic rate pre-intubation
3. High flow (in order to allow for a prolonged expiratory phase)
4. if nothing is working take them off the ventilator and manually BVM while watching for complete exhalation

Question 3

treatment considerations for massive hemoptysis/ pulmonary hemorrhage

Answer 3

1. Early intubation
2. Consider unilateral lung isolation with selective intubation of the “good lung” and lung “isolation” of the bad lung
3. Dependent positioning. Trendelenburg with “bad side” down (theoretical belief to minimize reflux of blood into normal lung)
4. High PEEP to improve V/Q matching
5. If major pulmonary haemorrhage target SBP <140 mmHg
6. Consider IV TXA. If patient is not intubated and can tolerate it, consider nebulizer TXA

Question 4

CCP approach to mech vent (what you should ask yourself ANY time you approach a mechanically ventilated patient)

Answer 4

1. Am I adequately oxygenating (PaO2)
2. Am I ventilating appropriately (PaCO2)
3. Am I on safe ground (oxygenation + ventilation + hemodynamics)
4. Current acid/base status
5. Delta

Question 5

Asthma treatment pathway

Answer 5

1. Oxygen (target SpO2 >90%)
2. inhaled β-agonist and anticholinergic (salbutamol + ipratropium) [If patient has inhaled corticosteroid inhaler use this also
3. Systemic corticosteroids (methylprednisolone)
4. MgSO4 infusion
5. BiPAP (plus/minus depending how sick they are)
6. Epinephrine (first IM, then IV. straight to IV if crashing)
7. Intubation (ketamine induction, consider epi over phenyl for your hemodynamic support agent)
8. Ketamine infusion therapy (ketamine maintenance of anesthesia)

Question 6

Acute exacerbation of COPD (AECOPD) treatment algorithm

Answer 6

1. Oxygen (Goal saturation 88-92%)
2. Beta Adrenergic Agonist (salbutamol)
3. Anticholinergic/bronchodilator (ipratropium)
4. Corticosteroids (Methylprednisolone)
5. Antibiotic coverage
6. NIPPV (BiPAP or HFNC as tolerated)
7. Intubation and MV