FCCS questions with complete solutions 2023

FCCS questions with complete solutions 2023What is the first indicator of critical illness Tachypnea Evidence of decreased perfusion include? AMS, Urine output, skin temperature DIRECT Detection, intervention, Reassessment, effective communication, teamwork Late sign of circulatory demise hypotension Important indicator of critical illness Metabolic acidosis -> lactacte measurement -> anaerobic metabolism What does metabolic acidosis suggest? hypo perfusion 1st priority in managing a critical patient Stabilize first, then determine diagnosis and definitive treatment Define Sepsis life-threatening organ dysfunction cause by host response to infection Define Septic Shock Clinical sepsis requiring vasopressors to maintain a MAP > 65mmHg and Lactate > 2mmol/L despite volume resuscitation Most common clinical presentation of infection Fever (hypothermia has very poor prognosis) Morbidity related to sepsis can be predicted by... AMS, SBP < 100mmHg, RR > 22 Antibiotic regimen for community-acquired PNA in the immunocompetent? Beta-Lactam + Macrolide or Fluoroquinolone Antibiotic for aspiration PNA Clindamycin Antibiotic regimen for the community-acquired PNA in the immunocompromised? Trimethroprim-sulfamethoxazole (bactrim) and anti fungal agent Antibiotic for S. Aureus? Vancomycin or Linezolid Antibiotics for nosocomial and ventilator-associated PNA? Cephalosporin 3rd/4th gen, Beta-lactam, or carbapenem Antibiotic for pseudomonas? Antipseudomonal beta-lactam (piperacillin-tazobactam, cefepime, imipenem, meropenem) Most common pathogens for meningitis? Neisseria and Strep Pneumoniae Most common pathogen in severe community-acquired PNA? S. Pneumoniae Pathogens commonly associated with hospital-acquired PNA? Gram-negative & S. Aureus Necrotizing soft-tissue infections require surgical debridement and antimicrobial therapy immediately What is the minimum pH patients will tolerate 7.20 What is normal tidal volume 6-8ml/kg of IBW What is normal minute ventilation? 7,000-8,000 Normal inspiratory time in adult 1 sec, COPD -> up to 3 seconds Normal expiration time 2 seconds Minute ventilation equation MV = RR x TV Where should the ETT terminate on the chest XR? 2-6cm above the carina (below the clavicle, above the heart) What is the optimal peak inspiratory pressure on the ventilator? < 35mmHg What is the optimal plateau pressure on the ventilator? < 30 mmHg What is the best indicator of alveolar trauma? Plateau pressure What are the consequences of Auto-PEEP Increased inspiratory pressure, hypotension, worsened oxygenation What interventions can you attempt to avoid auto-PEEPing? Decrease RR, Decrease TV, Increase Gas Flow Rate What is a normal gas flow rate? 4x the patient's minute ventilation, increasing flow can help to increase the TV What two factors affect oxygenation? FiO2 & Mean Airway Pressure (PEEP) What factors affect ventilation? Minute Ventilation = RR x TV, higher the MV the lower the CO2 What are some determinate of oxygenation? FiO2 & Mean Airway Pressure (TV, I:E, PEEP, Inspiratory flow rate, Auto-PEEP) What is the recommended TV for ARDs? 4-6ml/kg with permissive hypercapnia what should the difference between peak pressure and plateau pressure be? No more than 5 mmHg, greater than 5 = airway resistance Causes of hypotension in ventilated patient? Postive intrathoracic pressure, hypovolemia, myocardial ischemia, tension pneumothorax, auto-PEEP What are the s/s of a tensions pneumothorax? tracheal deviation, unilateral breath sounds