FCCN 2 REVIEW UPDATED QUESTIONS AND
ANSWERS SURE A+
✔✔ARDS severity - ✔✔look at P/F ratio
mild: 200-300
moderate: 100-200
severe: <100
✔✔injury to alveoli - ✔✔-causes release of proinflammatory cytokines
-cytokines recruit neutrophils to the lungs
-neutrophils become active and release toxic mediators
-damage to capillary endothelium and alveolar epithelium
-proteins leak out from vascular space
-normal oncotic gradient, fluid doesn't stay where it should. gets into airways and
interstitial spaces
✔✔ARDS s/s - ✔✔-hypoxemia after pulmonary insult
-bilateral opacities
-crackly lungs
-diaphoresis
-chest pain
-cough
-accessory muscle use
-rapid deterioration
-increasing demand for supplemental oxygen
✔✔ARDS treatment - ✔✔-treat underlying cause
-prevent progression of lung injury
-promote gas exchange
-high pressure ventilation (PEEP)
-high level O2 therapy to keep PaO2 >60
-support tissue oxygenation
,-prevent complications
✔✔ARDS management strategies - ✔✔-low tidal volume ventilation
-recruit PEEP
-monitor plateau pressure
-pulmonary vasodilatos
-neuromuscular blockers
-proning
-ECMO
✔✔low tidal volume ventilation - ✔✔goal is <6mL/kg to prevent over distending alveoli.
helps sustain surfactant production
✔✔recruiting PEEP - ✔✔keeps alveoli open, improving oxygenation using lower FiO2.
this however can drop pt's BP due to decreased venous return and can also cause
barotrauma
✔✔plateau pressure - ✔✔the pressure exerted on small airways and alveoli during
mechanical ventilation. measures compliance of the entire lung. keep below 30 to
prevent over distention of alveoli
✔✔pulmonary vasodilators - ✔✔specifically dilate pulmonary blood vessels
ex:
-epoprostenol (continuous infusion)
-alprostadil (inhaled)
-nitric oxide (inhaled)
✔✔neuromuscular blockers - ✔✔to paralyze our pt, which decreases O2 consumption
✔✔proning - ✔✔optimizes ventilation and perfusion to lungs. improves gas exchange,
reduces pleural pressure, improves secretion removal. prone for 16hrs then supine for 8
risks: hemodynamic instability, skin breakdown, facial edema, emesis, unintentional
extubation
✔✔ECMO - ✔✔extracorporeal membrane oxygenation. large-bore catheters are
inserted, blood is removed, oxygenated, CO2 is removed, and then returned to body
✔✔peripheral nerve stimulator - ✔✔a battery-operated device used to assess the level
of neuromuscular blockade by causing muscle contractions
✔✔neuromuscular blockade - ✔✔acute muscle paralysis and apnea, reserved for pts
with severe, refractory, or life threatening hypoxemia who are not responsive to other
sedatives or analgesics
, classified as depolarizing or non-depolarizing
goal is to deliver minimum amount of medication to achieve desired effect
✔✔NMB agents indications - ✔✔-facilitate short procedures
-facilitate mechanical ventilation
-reduce muscle oxygen consumption
-prevent respiratory or other movements
-treat increased muscle activity
✔✔neuromuscular junction - ✔✔point of contact between a motor neuron and a skeletal
muscle cell
-impulse travels down motor axon resulting in influx of calcium
-calcium generates release of ACh
-ACh crosses into synaptic cleft and binds to receptors
-membrane permeability increases, allowing for exchange of Na and K
-this initiates depolarization and an action potential, which produces muscle contraction
✔✔depolarizing agents - ✔✔mimic ACh
Bind to ACh receptor on motor end plate and depolarize post junctional neuromuscular
membrane. paralysis occurs because depolarized membrane can't respond to
subsequent stimuli by ACh
succinylcholine
✔✔succinylcholine - ✔✔rapid onset 30-60 seconds, ultra short duration, absence of
adverse effects on smooth muscle
metabolized in blood and excreted by kidneys
side effects: hypotension, bradycardia, hyperkalemia, malignant hyperthermia
✔✔non-depolarizing agents - ✔✔competitively block ACh transmission at post-
junctional receptor sites. level of paralysis increases as number of receptor sites
occupied by drug increases
pancuronium, atracurium, cisatracurium, vec, roc
✔✔NMB considerations - ✔✔NMBs do not have sedative analgesic or amnestic
properties. assure pain and sedation medication given beforehand.
precedex should not be used due to light sedative properties
ANSWERS SURE A+
✔✔ARDS severity - ✔✔look at P/F ratio
mild: 200-300
moderate: 100-200
severe: <100
✔✔injury to alveoli - ✔✔-causes release of proinflammatory cytokines
-cytokines recruit neutrophils to the lungs
-neutrophils become active and release toxic mediators
-damage to capillary endothelium and alveolar epithelium
-proteins leak out from vascular space
-normal oncotic gradient, fluid doesn't stay where it should. gets into airways and
interstitial spaces
✔✔ARDS s/s - ✔✔-hypoxemia after pulmonary insult
-bilateral opacities
-crackly lungs
-diaphoresis
-chest pain
-cough
-accessory muscle use
-rapid deterioration
-increasing demand for supplemental oxygen
✔✔ARDS treatment - ✔✔-treat underlying cause
-prevent progression of lung injury
-promote gas exchange
-high pressure ventilation (PEEP)
-high level O2 therapy to keep PaO2 >60
-support tissue oxygenation
,-prevent complications
✔✔ARDS management strategies - ✔✔-low tidal volume ventilation
-recruit PEEP
-monitor plateau pressure
-pulmonary vasodilatos
-neuromuscular blockers
-proning
-ECMO
✔✔low tidal volume ventilation - ✔✔goal is <6mL/kg to prevent over distending alveoli.
helps sustain surfactant production
✔✔recruiting PEEP - ✔✔keeps alveoli open, improving oxygenation using lower FiO2.
this however can drop pt's BP due to decreased venous return and can also cause
barotrauma
✔✔plateau pressure - ✔✔the pressure exerted on small airways and alveoli during
mechanical ventilation. measures compliance of the entire lung. keep below 30 to
prevent over distention of alveoli
✔✔pulmonary vasodilators - ✔✔specifically dilate pulmonary blood vessels
ex:
-epoprostenol (continuous infusion)
-alprostadil (inhaled)
-nitric oxide (inhaled)
✔✔neuromuscular blockers - ✔✔to paralyze our pt, which decreases O2 consumption
✔✔proning - ✔✔optimizes ventilation and perfusion to lungs. improves gas exchange,
reduces pleural pressure, improves secretion removal. prone for 16hrs then supine for 8
risks: hemodynamic instability, skin breakdown, facial edema, emesis, unintentional
extubation
✔✔ECMO - ✔✔extracorporeal membrane oxygenation. large-bore catheters are
inserted, blood is removed, oxygenated, CO2 is removed, and then returned to body
✔✔peripheral nerve stimulator - ✔✔a battery-operated device used to assess the level
of neuromuscular blockade by causing muscle contractions
✔✔neuromuscular blockade - ✔✔acute muscle paralysis and apnea, reserved for pts
with severe, refractory, or life threatening hypoxemia who are not responsive to other
sedatives or analgesics
, classified as depolarizing or non-depolarizing
goal is to deliver minimum amount of medication to achieve desired effect
✔✔NMB agents indications - ✔✔-facilitate short procedures
-facilitate mechanical ventilation
-reduce muscle oxygen consumption
-prevent respiratory or other movements
-treat increased muscle activity
✔✔neuromuscular junction - ✔✔point of contact between a motor neuron and a skeletal
muscle cell
-impulse travels down motor axon resulting in influx of calcium
-calcium generates release of ACh
-ACh crosses into synaptic cleft and binds to receptors
-membrane permeability increases, allowing for exchange of Na and K
-this initiates depolarization and an action potential, which produces muscle contraction
✔✔depolarizing agents - ✔✔mimic ACh
Bind to ACh receptor on motor end plate and depolarize post junctional neuromuscular
membrane. paralysis occurs because depolarized membrane can't respond to
subsequent stimuli by ACh
succinylcholine
✔✔succinylcholine - ✔✔rapid onset 30-60 seconds, ultra short duration, absence of
adverse effects on smooth muscle
metabolized in blood and excreted by kidneys
side effects: hypotension, bradycardia, hyperkalemia, malignant hyperthermia
✔✔non-depolarizing agents - ✔✔competitively block ACh transmission at post-
junctional receptor sites. level of paralysis increases as number of receptor sites
occupied by drug increases
pancuronium, atracurium, cisatracurium, vec, roc
✔✔NMB considerations - ✔✔NMBs do not have sedative analgesic or amnestic
properties. assure pain and sedation medication given beforehand.
precedex should not be used due to light sedative properties
