Respiratory Emergencies and Mechanical Ventilation

Question 1

Bare minimum history you need to obtain from a pulmonary patient

Answer 1

allergies, medications, past illnesses, last meal, events preceding episode that brought them in

Question 2

Partial pressures for qualification of acute respiratory failure

Answer 2

PO2 is < 60 mmHg or PCO2 is > 50 mmHg

Question 3

What sign of hypoxemia is usually observed before a patient crashes?

Answer 3

restlessness

Question 4

Patients who should be considered for non-invasive positive pressure ventilation

Answer 4

patients who can protect/maintain their airway. Commonly used for COPD exacerbations

Question 5

Most common cause of ARDS

Answer 5

sepsis

Question 6

Why should you use the lowest level of PEEP (positve end expiratory pressure) when treating ARDS?

Answer 6

too much can decrease cardiac output

Question 7

Which of the following describe hypobaric hypoxic condition: fluid retention, vasoconstriction, pulmonary artery HTN, increased endothelial permeability, edema?

Answer 7

All of them describe hypobaric hypoxic condition

Question 8

Medical treatment for acute mountain sickness

Answer 8

Acetazolamide. Or alternative dexamethasone

Question 9

Hallmarks of high altitude cerebral edema

Answer 9

altered consciousness and ataxic gait

Question 10

What is the most common fatal manifestation of high altitude illness?

Answer 10

High altitude pulmonary edema (HAPE)

Question 11

Important clinical sign of high altitude sickness

Answer 11

dyspnea at rest

Question 12

Medical therapy of high altitude pulmonary edema

Answer 12

Acetazolamide, dexamethasone, sildenafil, nifedipine, salmeterol

Question 13

What factors contribute to the impaired oxygenation of smoke inhalation?

Answer 13

Hypoxemic gas mixture, Carbon monoxide, Cyanide, and V/Q mismatching

Question 14

Causes of thermal injury of the upper airway

Answer 14

mucosal edema, upper airway obstruction, inability to clear oral secretions

Question 15

Treatment of smoke inhalation

Answer 15

humidified O2, bronchodilators, intubation, PEEP if bronchiolar edema

Question 16

How many peach pits would you have to ingest for a lethal dose os cyanide poisoning?

Answer 16

4

Question 17

Pathophysiology of cyanide poisoning

Answer 17

patients CANNOT release oxygen from oxyhemoglobin which results in higher venous PaO2 and severe tissue hypoxia

Question 18

Signs of cyanide poisoning

Answer 18

Increased lactate production, Anion gap metabolic acidosis, and Elevated venous oxygen saturation

Question 19

three pronged approach to the treatment of cyanide poisoning

Answer 19

Inhaled nitrites (amyl nitrites), Injected nitrites (sodium nitrite), and Injected Sodium Thiosulfate

Question 20

Under what conditions is the three pronged approach to cyanide poisoning contraindicated?

Answer 20

concomitant carbon monoxide poisoning

Question 21

Pathophysiology of carbon monoxide poisoning

Answer 21

inability to transport O2 via hemoglobin. CO binds with Hgb 230-270 times stronger than with O2

Question 22

Classic sign of carbon monoxide poisoning

Answer 22

“cherry red” coloring of the skin

Question 23

Treatment for carbon monoxide poisoning

Answer 23

administration of 100% O2 for 4 hours. Hyperbaric oxygen therapy in severe cases

Question 24

Classic EKG findings of pulmonary embolism

Answer 24

S1Q3T3 (S waves in lead I, Q waves in lead III, and inverted T waves in lead III) and tachycardia

Question 25

Treatment of PE

Answer 25

O2, heparin, fibrinolytics if hemodynamic compromise, anticoagulation for 3-6 months. Inferior vena cava filter if large clot burden or unable to anticoagulate the patient

Question 26

At what peak flow is an acute asthma attack considered severe?

Answer 26

Peak flow less then 40 % of predicted

Question 27

When should you give magnesium sulfate for an acute asthma attack?

Answer 27

For life threatening exacerbations that remain severe after 1 h of intense bronchodilator therapy

Question 28

What two meds should not be used together for severe asthma attack unresponsive to bronchodilatrs?

Answer 28

epi and terbutaline

Question 29

What is the difference between wet and dry drowning?

Answer 29

Wet- Aspiration of fluid or foreign material | Dry- Laryngospasm or airway obstruction

Question 30

Pathophysiology of drowning

Answer 30

V/Q mismatch, Intrapulmonary shunting, Decreased compliance

Question 31

End organ effects of drowning

Answer 31

metabolic and/or respiratory acidosis. sinus bradycardia and V. fib

Question 32

How long should resuscitative efforts be continued in hypothermic patients?

Answer 32

continued until the pts temperature is 32-35C (90-95F)

Question 33

When should you suspect a tension pneumothorax?

Answer 33

labored breathing, tachycardia, hypotensive, tracheal shift, JVD

Question 34

Treatment for pneumothorax

Answer 34

needle decompression chest tube

Question 35

Name two advantages of negative pressure ventilation ("iron lung")

Answer 35

Allows long-term ventilation without artificial airway. Maintains normal intrathoracic hemodynamics

Question 36

For abnormal ABGs in a mechanically intubated patient, how can you adjust pH/pCO2?

Answer 36

vent settings- TV, RR, PS

Question 37

For abnormal ABGs in a mechanically intubated patient, how can you adjust pO2, SO2?

Answer 37

vent settings - FIO2, PEEP/CPAP