Air Methods Critical Care exam
3rd degree AV block - ANSWER ✔ P wave independent of QRS
A 36 yo patient presents in VTACH what is the most appropriate drug?
A.Amiodarone (Cordarone)
B.Verapamil (Calan)
C.Adenosine (Adenocard)
D.Ibutilide (Corvert) - ANSWER ✔ The first drug for a wide QRS complex
tachycardia is amiodarone. If the rhythm does not respond to amiodarone,
synchronized cardioversion is indicated.
Verapamil and adenosine typically are used for narrow QRS complex
tachycardia. Eliminate options b and c. Ibutilide is used for acute-onset
atrial fibrillation. This rhythm is regular, so eliminate option d and choose
option a.
A 45 yo is placed on VV ECMO due to severe ARDS.
,ABG is obtained after 2 hours on ECMO support and shows the following:
pH 7.11, PCO2 63, PaO2 126.
What is the most appropriate action?
Increase RR on ventilator
Decrease sweep gas flow
Increasing ECMO blood flow
Increasing sweep gas flow - ANSWER ✔ Increasing sweep gas flow]
Although the problem is hypercapnia, increasing the RR in a patient with
severe ARDS is unlikely to improve PCO2. When on ECMO support,
oxygenation and ventilation are controlled by ECMO circuit. Decreasing
sweep gas flow would decrease CO2 removal and increase PCO2.
Increasing sweep gas flow increases CO2 removal and decreases PCO2
A 45 yo male is placed on VV ECMO d/t severe ARDS
An ABG is obtained after 2 hours on ECMO support and shows the
following:
pH 7.37, PCO2 35, PaO2 64. SpO2 78%
,What is the most appropriate action? - ANSWER ✔ Increase ECMO blood
flow
Increasing FiO2 on the ventilator is unlikely to improve oxygen saturation in
a patient with severe ARDS. When on ECMO support, oxygenation and
ventilation are controlled by the ECMO circuit. Decreasing sweep gas flow
decreases CO2 removal and increases PCO2. Therefore, this patient
requires improved O2 Increase sweep gas flow oxygenation. Increasing
ECMO blood flow will increase oxygen delivery to the patient and improve
oxygenation
A 54 yo female is on VV ECMO support via internal jugular and femoral
veins. On Assessment, the patient's SpO2 is 72% with streaks of bright red
blood noted in the access/drainage cannula.
Attempts to increase ECMO flow result in worsening hypoxia. You realize
the patient is experiencing what? - ANSWER ✔ Recirculation
Differential Hypoxia is a complication unique to peripheral VA ECMO. This
pt. is on VV ECMO. Recirculation is a complication unique to VV ECMO in
, which oxygenation blood returning from the ECMO circuit is redireted back
into the access/drainage cannula resulting in hypoxia d/t the reduction of
oxygen delivery to the body. Suck-down is the stoppage of ECMO flow d/t
low intravascular volume and excessive access to negative pressure.
A 65 year old male presents with CP 8/10 that lessens when leaning
forward. In addition, 12 lead reveals diffuse ST elevation across most
leads.
The patient is most likely suffering from what? - ANSWER ✔ Acute
pericarditis.
The patient will present with CP but also with pericardial friction rub that
can be relieved with positioning. The 12 lead with show global ST changes
and T wave abnormalities.
A holistic murmur at the left sternal border means the - ANSWER ✔ the
tricuspid valve is most likely affected.
A lactate level of > ___ is a poor prognostic sign - ANSWER ✔ Lactate > 4
3rd degree AV block - ANSWER ✔ P wave independent of QRS
A 36 yo patient presents in VTACH what is the most appropriate drug?
A.Amiodarone (Cordarone)
B.Verapamil (Calan)
C.Adenosine (Adenocard)
D.Ibutilide (Corvert) - ANSWER ✔ The first drug for a wide QRS complex
tachycardia is amiodarone. If the rhythm does not respond to amiodarone,
synchronized cardioversion is indicated.
Verapamil and adenosine typically are used for narrow QRS complex
tachycardia. Eliminate options b and c. Ibutilide is used for acute-onset
atrial fibrillation. This rhythm is regular, so eliminate option d and choose
option a.
A 45 yo is placed on VV ECMO due to severe ARDS.
,ABG is obtained after 2 hours on ECMO support and shows the following:
pH 7.11, PCO2 63, PaO2 126.
What is the most appropriate action?
Increase RR on ventilator
Decrease sweep gas flow
Increasing ECMO blood flow
Increasing sweep gas flow - ANSWER ✔ Increasing sweep gas flow]
Although the problem is hypercapnia, increasing the RR in a patient with
severe ARDS is unlikely to improve PCO2. When on ECMO support,
oxygenation and ventilation are controlled by ECMO circuit. Decreasing
sweep gas flow would decrease CO2 removal and increase PCO2.
Increasing sweep gas flow increases CO2 removal and decreases PCO2
A 45 yo male is placed on VV ECMO d/t severe ARDS
An ABG is obtained after 2 hours on ECMO support and shows the
following:
pH 7.37, PCO2 35, PaO2 64. SpO2 78%
,What is the most appropriate action? - ANSWER ✔ Increase ECMO blood
flow
Increasing FiO2 on the ventilator is unlikely to improve oxygen saturation in
a patient with severe ARDS. When on ECMO support, oxygenation and
ventilation are controlled by the ECMO circuit. Decreasing sweep gas flow
decreases CO2 removal and increases PCO2. Therefore, this patient
requires improved O2 Increase sweep gas flow oxygenation. Increasing
ECMO blood flow will increase oxygen delivery to the patient and improve
oxygenation
A 54 yo female is on VV ECMO support via internal jugular and femoral
veins. On Assessment, the patient's SpO2 is 72% with streaks of bright red
blood noted in the access/drainage cannula.
Attempts to increase ECMO flow result in worsening hypoxia. You realize
the patient is experiencing what? - ANSWER ✔ Recirculation
Differential Hypoxia is a complication unique to peripheral VA ECMO. This
pt. is on VV ECMO. Recirculation is a complication unique to VV ECMO in
, which oxygenation blood returning from the ECMO circuit is redireted back
into the access/drainage cannula resulting in hypoxia d/t the reduction of
oxygen delivery to the body. Suck-down is the stoppage of ECMO flow d/t
low intravascular volume and excessive access to negative pressure.
A 65 year old male presents with CP 8/10 that lessens when leaning
forward. In addition, 12 lead reveals diffuse ST elevation across most
leads.
The patient is most likely suffering from what? - ANSWER ✔ Acute
pericarditis.
The patient will present with CP but also with pericardial friction rub that
can be relieved with positioning. The 12 lead with show global ST changes
and T wave abnormalities.
A holistic murmur at the left sternal border means the - ANSWER ✔ the
tricuspid valve is most likely affected.
A lactate level of > ___ is a poor prognostic sign - ANSWER ✔ Lactate > 4
