NBRC RRT-CSE, Treating Pathologies, According to
Kettering.
Emphysema - Correct Answer • O2 therapy via nasal cannula at 24-28%. Keep
saturations at approx. 88%-93%.
• Bronchodilators
• Bronchial hygiene as indicated.
• NIPPV for acute vent failure (PaCO2>45 torr)
Chronic Bronchitis - Correct Answer • O2 therapy via nasal cannula at 24-28%. Keep
saturations at approx. 88%-93%.
• Bronchodilators
• Bronchial hygiene as indicated
• Antibiotics as indicated
• NIPPV for acute vent failure (PaCO2>45 torr)
Chest Trauma/Flail Chest/Rib Fractures - Correct Answer • Hyperinflation therapy
(IS/SMI, IPPB. Prevent atelectasis and pneumonia)
• Analgesics
• Mech Vent w/ PEEP for severe case
• Severe cases may require surgery.
Pneumothorax - Correct Answer • Small pneumo (<20% lung collapse): bed rest
• Large pneumo (>20% lung collapse): chest tube
• Needle thoracentesis if pt is unstable (bradycardia, hypotension, cyanosis, etc.)
• Hyperinflation therapy post-chest tube insertion
Hemothorax - Correct Answer • Thoracentesis or chest tube
• Hyperinflation therapy post-chest tube insertion
Burns/Smoke Inhalation/CO Poisoning - Correct Answer • Immediate assessment of pt's
airway: Intubation for marked/severe distress/stridor.
, • O2 therapy at 100%.
• Hyperbaric O2 therapy for CO poisoning.
• Monitor for signs of infections.
• Immediate insertion of IV line and monitor basic lab tests + fluid levels
Acute Respiratory Distress Syndrome (ARDS) - Correct Answer • Treat underlying cause
• Increase FiO2 as high as 0.60 and then add PEEP.
• Implement ARDSNet protocol: Vt of 4-6mL/kg; Pplat<30cmH2O
• Consider alternative modes of ventilation (IRV, APRV, HFV, etc.)
• Prone positioning
Myasthenia Gravis - Correct Answer • If Vt, VC, and MIP improve with Tensilon: Give "-
stigmine" drugs/Mestinon
• If Vt, VC, and MIP worsen with Tensilon: Give atropine
• If Vt drops below 6mL/kg, VC drops below 1000mL, or MIP drops below -20cmH2O,
INTUBATE
• Recommend Hyperinflation therapy and pulmonary hygiene
Guillain-Barre Syndrome - Correct Answer • Monitor Vt, VC, and MIP until they reach the
criteria for intubation
• Recommend hyperinflation therapy and pulmonary hygiene
• Plasmapheresis: in severe cases.
Chest Pain/MI - Correct Answer • Immediate O2 therapy at 100%
• Aspirin
• Anti-arrhythmic agents as indicated: Amiodarone to slow HR, Atropine to speed HR, etc.
• Nitrates for chest pain
• Maintain BP with fluids or vasopressors (dopamine)
• Defibrillate for PVT or V-fib.
CHF/Pulmonary Edema - Correct Answer • Immediate O2 therapy at 100%
Kettering.
Emphysema - Correct Answer • O2 therapy via nasal cannula at 24-28%. Keep
saturations at approx. 88%-93%.
• Bronchodilators
• Bronchial hygiene as indicated.
• NIPPV for acute vent failure (PaCO2>45 torr)
Chronic Bronchitis - Correct Answer • O2 therapy via nasal cannula at 24-28%. Keep
saturations at approx. 88%-93%.
• Bronchodilators
• Bronchial hygiene as indicated
• Antibiotics as indicated
• NIPPV for acute vent failure (PaCO2>45 torr)
Chest Trauma/Flail Chest/Rib Fractures - Correct Answer • Hyperinflation therapy
(IS/SMI, IPPB. Prevent atelectasis and pneumonia)
• Analgesics
• Mech Vent w/ PEEP for severe case
• Severe cases may require surgery.
Pneumothorax - Correct Answer • Small pneumo (<20% lung collapse): bed rest
• Large pneumo (>20% lung collapse): chest tube
• Needle thoracentesis if pt is unstable (bradycardia, hypotension, cyanosis, etc.)
• Hyperinflation therapy post-chest tube insertion
Hemothorax - Correct Answer • Thoracentesis or chest tube
• Hyperinflation therapy post-chest tube insertion
Burns/Smoke Inhalation/CO Poisoning - Correct Answer • Immediate assessment of pt's
airway: Intubation for marked/severe distress/stridor.
, • O2 therapy at 100%.
• Hyperbaric O2 therapy for CO poisoning.
• Monitor for signs of infections.
• Immediate insertion of IV line and monitor basic lab tests + fluid levels
Acute Respiratory Distress Syndrome (ARDS) - Correct Answer • Treat underlying cause
• Increase FiO2 as high as 0.60 and then add PEEP.
• Implement ARDSNet protocol: Vt of 4-6mL/kg; Pplat<30cmH2O
• Consider alternative modes of ventilation (IRV, APRV, HFV, etc.)
• Prone positioning
Myasthenia Gravis - Correct Answer • If Vt, VC, and MIP improve with Tensilon: Give "-
stigmine" drugs/Mestinon
• If Vt, VC, and MIP worsen with Tensilon: Give atropine
• If Vt drops below 6mL/kg, VC drops below 1000mL, or MIP drops below -20cmH2O,
INTUBATE
• Recommend Hyperinflation therapy and pulmonary hygiene
Guillain-Barre Syndrome - Correct Answer • Monitor Vt, VC, and MIP until they reach the
criteria for intubation
• Recommend hyperinflation therapy and pulmonary hygiene
• Plasmapheresis: in severe cases.
Chest Pain/MI - Correct Answer • Immediate O2 therapy at 100%
• Aspirin
• Anti-arrhythmic agents as indicated: Amiodarone to slow HR, Atropine to speed HR, etc.
• Nitrates for chest pain
• Maintain BP with fluids or vasopressors (dopamine)
• Defibrillate for PVT or V-fib.
CHF/Pulmonary Edema - Correct Answer • Immediate O2 therapy at 100%
