Respiratory

Question 1

Thumbprint sign

Answer 1

Possible epiglottitis (lateral neck view)

Question 2

ABG values:

Answer 2

pCO2 high= pH low (acidosis)
pCO2 low= pH high (alkalosis)

pH low= HCO3 low (acidosis)
pH high= HCO3 high (alkalosis)

pCO2= 35-45 respiratory
pH= 7.35-7.45 metabolic
HCO3= 22-26 metabolic

Question 3

First adjustment on ventilator

Answer 3

Tidal volume, not rate

Question 4

PaO2

Answer 4

Plasma measured as pressure

Question 5

SaO2

Answer 5

Hemoglobin measured as percentage

Question 6

Bariobariatrauma

Answer 6

Nitrogen release in obese patients, administer high flow oxygen 15 minutes to lift off to wash out nitrogen

Question 7

Three killers of ventilator patients during flight

Answer 7

Pericardial tamponade
Tension pneumothorax
Hypovolemia

Question 8

Hypoxic hypoxia

Answer 8

Altitude hypoxia, decreased alveolar oxygen, tension pneumo (e.g., altitude)

Question 9

Hypemic hypoxia

Answer 9

Decreased O2 carrying capacity in blood

Question 10

Histotoxic hypoxia

Answer 10

Poisoning (e.g., nitrates)

Question 11

Stagnant hypoxia

Answer 11

Decreased cardiac output, poor circulation ( e.g., g-forces, CHF)

Question 12

Primary cause of death with ventilator dependent patients

Answer 12

Ventilator acquired pneumonia

Question 13

ARDS:
Treatment
CXR

Answer 13

Treatment: PEEP
CXR: CXR reveals widespread pulmonary infiltrates; glass-like appearance

Question 14

PEEP:
Effects of PEEP
Normal physiological PEEP

Answer 14

Increased pulmonary vascular resistance
Can cause hypotension over 15 cm H2O
Normal range: 3-5 cm H2O

Question 15

To change CO2

Answer 15

Adjust rate, tidal volume

Question 16

To change oxygenation

Answer 16

Adjust PEEP, PAP

Question 17

O2 adjustment calculation to maintain saturation at altitude

Answer 17

% oxygen patient is already on X pressure at departure (mmHg) pressure at altitude. This percentage needed in flight.
Example: Patient on FIO2 of 0.40
Depart: 681 mm Hg
Altitude: 565 mm Hg
Answer: patient needs 48% oxygen

Question 18

Ventilator modes:

CMV

Answer 18

Preset volume or PIP at set rate. Patient can’t initiate breath.

Question 19

Ventilator modes:

AC

Answer 19

Preset volume or PIP with every breath. Can trigger breath, can’t control tidal volume

Question 20

Ventilator modes:

IMV/SIMV

Answer 20

IMV: preset breaths, TV, PIP. Patient breaths allowed.
SIMV: allows variation of support

Question 21

Oxyhemoglobin disassociation curve:

Left shift

Answer 21

“L” stands for alkalosis
Left shift= low hemoglobin holding oxygen alkalosis

Low CO2
Low temperature
Low DPG
Mxydema coma

Question 22

Oxyhemoglobin disassociation curve:

Right shift

Answer 22

Right=raise/releases oxygen
Acidosis
Raised CO2

Raised temperature
Raised DPG
Thyroid storm

Question 23

ABG rules

CO2 and pH

Answer 23

CO2 up 10= pH down .08(inverse)

Question 24

ABG rules

Bicarbonate and pH

Answer 24

HCO3 up 10= pH up 15 (proportional)

Question 25

ABG rules:

Bicarb replacement

Answer 25

kg/4 x base deficit = meq of bicarbonate needed

Question 26

ABG rules:

PaO2 at altitude

Answer 26

PaO2 drops 5 for every 1000 feet elevation

Question 27

Stages of hypoxia:
Elevation
Signs or symptoms

Answer 27

Indifferent: (10,000 feet MSL): increased HR and RR, decreased night vision

Compensatory: (10, 000-15,000 feet MSL):HTN, task impairment

Disturbance: (15,000-20,000 feet MSL): dizzy, sleepy, cyanosis

Critical: ( 20,000-30, 000 feet MSL): ALOC, incapacitated

Question 28

Acute respiratory failure

Answer 28

pO2 below 60, pCO2 above 50

Question 29

Breathing and waveforms

Answer 29

Record pressure measurements at the end of exhalation

• in a spontaneously breathing patient, inspiration is the fall in pressure, expiration is the rise in pressure. End-expiration occurs just prior to the respiratory drop in pressure.
• positive pressure mechanical ventilated patients will cause cardiac pressure to rise upon inspiration

Question 30

Steeple sign

Answer 30

Possible croup (laryngotracheobronchitis) A/P neck view

Question 31

ETT depth

Answer 31

Adult: 3 x ETT size or average is 19-23cm
Peds: 10 + age in years
Neonatal: 6 + age weight in kg