General critical care -ACCS exam (2022/2023) rated A+

General critical care -ACCS exam (2022/2023) rated A+ What is the thyromental distance? Measurement of the distance between the upper edge of the thyroid cartilage to the chin, while the neck is completely extended. Thyromental distance: what indicates a suspected difficult intubation? Less than 6 cm Thyromental distance: what suggests a non-problematic intubation? 7 cm or greater What type of x-ray should you use to determine proper position of an endotracheal tube? AP x-ray What type of x-ray is helpful in detecting pleural effusions? Lateral decubitus The description "concave superior border or interface" describes what? A pleural effusion What type of x-ray is helpful and spotting internal issues such as masses, blebs, or lesions? Oblique x-ray On x-ray, where should the end of the endotracheal tube be positioned? 2-5 cm above the carina On x-ray, where should the central venous catheter be positioned? The tip should rest in the right atrium or vena cava On x-ray, where should the pulmonary artery catheter be positioned? The tip should be over the right lower lung field What type of diagnostic imaging is used to detect the functionality of organs? PET scan What is the gas the patient breathes during a V/Q scan? Xenon On V/Q scan, what do dark areas of the lungs indicate? Absence of ventilation in that area On V/Q scan, the description "wedge shaped" indicates what? A clot What is considered normal work of breathing? 0.5-0.7 J/L Three key criteria for brain death 1. Unresponsiveness 2. Absence of reflexes 3. Presence of apnea Normal stroke volume 50-100 mL Normal ejection fraction 50-70% The best lead to determine the left ventricle status V5 The best lead to determine overall electrical condition of the heart Lead II Hypertrophy will cause an axis deviation in what direction? In the direction of the hypertrophy, usually to the left, as in CHF If tissues are infarcted or dead, the axis will deviate where? Away from the infarcted tissue Myocardial ischemia is what? A current lack of oxygen to the cardiac muscle. Myocardial ischemia shows as what on an EKG? Flipped T waves Myocardial injury is what? Cardiac tissue currently dying How does Myocardial injury present on EKG? Elevated ST segments Myocardial infarction is what? Dead cardiac tissue, old or fresh How does myocardial infarction present on EKG? Profound Q waves Normal CVP range 2-6 mmHg Normal PAP 25/8 mmHg or 14 Normal PCWP (pulmonary capillary wedge pressure) 4-12 mmHg or 8 mmHg Where is the best place to get a mixed venous sample? PAP Normal cardiac output 4-8 L/min Normal MAP range 85-100 mmHg What is the most common complication of PA catheter insertion? Cardiac arrhythmias Once the PA catheter is in the right atrium, what is the next? The balloon is inflated and the catheter flows into the pulmonary artery where the balloon is deflated What is the dicrotic notch indicative of? It represents the closure of the pulmonic valve If the dicrotic notch is not present, the situation is called what? Pressure dampening What does pressure dampening indicate? A possible obstruction to the PA catheter Four steps that should be taken to resolve pressure dampening 1. Check transducer dome for air bubbles 2. Aspirate - to remove a potential clot 3. Flush the catheter 4. Rotate the catheter It is very important to not _____ or _____ the catheter to address pressure dampening Advance, Withdrawal Where specifically should you draw a mixed venous sample? Distal lumen ____ Is the initial action for shock Fluid administration A pH of what indicates respiratory failure? 7.25 If a patient is given this drug and feels better, the patient is positive for myasthenia gravis Tensilon (edrophonium) If a patient crashes after Tensilon administration, this is called what? Anti-cholinergic crisis An anti-cholinergic crisis should be treated with what? Atropine Once VC falls below 1.0 L, what should you do? Intubate and mechanically ventilate If the cerebral spinal fluid comes back positive for protein, the patient is positive for what? Guillain-Barre Syndrome How should you treat fulminating pulmonary edema? -diuretic -100% oxygen -positive pressure ventilation -digitalis If PetCO2 is more than 10 mmHg less than PaCO2 what does this indicate? Deadspace ventilation/pulmonary embolism What does an AHI score greater than 30 indicate? Severe sleep apnea. The next step is to do a titration study How should central sleep apnea be treated? -Respiratory stimulating medication such as Doxapram -Ventilatory assistance with a ventilator If a patient has recently been transfused with blood/blood products, and they develop acute bilateral crackles, wheezing, and a fever with in the first six hours following transfusion, what does this indicate? TRALI/transfusion - related lung injury What does a GFR less than 15 mL/min indicate? Kidney failure Normal creatinine 0.6-1.2 mg/dL Normal BUN 6-24 mg/dL Normal INR when patient is not on anticoagulant medication 0.8-1.3 Target INR when thin blood is desirable 2.0-3.0 Therapeutic INR when taking Coumadin 1.5-2.0 Normal PT 10-15 sec Normal platelet count 150,000-400,000 If the urine color looks dark light dark tea, what could this indicate? Rhabdomylosis Normal hemoglobin 12-16 Normal RBCs 4-6 Normal hematocrit 45% Normal troponin 0.2 ug/L Normal BNP 300 Normal CK-MB 10.5 Hypokalemia will cause what on EKG? Flattened T waves Hyperkalemia will cause what on EKG? Spiked T waves When the arterial blood appears chocolate brown in color, what is this indicative of? Methemoglobinemia A chest tube must be clamped for how long to be discontinued? 24 hours VEST therapy should be set at what? 5-25 Hz IPV frequency should be set at what? 30 psi What type of items are allowed near the MRI machine? Only non-ferrous items Sepsis acquired in hospitals is most commonly from what? Urinary catheters and IVs During apnea testing, the patient's temp should be what? Normothermic What indicates a positive apnea test? -PaCO2 has risen by 60 torr -PaCO2 is at least 20 torr above baseline _____ is a medication often used with organ preservation because it helps to prevent hypotension Desmopressin If the pressure from an arterial line is different from the blood pressure cuff, which one should you trust? Trust the cuff pressure The vacuum pressure from the wall should be set high enough to achieve what? Continuous bubbling in the suction control bottle If there is no bubbling in the water-seal chamber, what is happening? Suction is not enough If a catheter site develops signs of infection, what should be done immediately? remove the catheter The inability to pass a suction catheter beyond the distal tip of the ETT suggests what? an obstruction If you are unable to pass a suction catheter beyond the distal tip of the ETT, what should you do? deflate the cuff and try to pass the catheter again If a chest tube is accidentally removed (in transport for ex), what should be done immediately? place petroleum jelly on the exit wound and dress with gauze and tape When a patient is on paralytic medications and on a ventilator, what alarm should you pay extra close attention to? low peep A method of pulmonary hygiene that can be used when suctioning and other efforts are insufficient mini-BAL Right atrium normal pressure 5/1 mmHg Right ventricle normal pressure 25/2 mmHg If the dicrotic notch is missing from the PA waveform and the pressure reading is 25/2, what needs to be done? inflate the balloon and advance the catheter A pt who is being mechanically ventilated in PC mode, has peak pressure of 47 cmH2O and a plateau pressure of 30 cmH2O. In addition, the pt is becoming harder to ventilate and is not oxygenating adequately. What should be done to remedy this? switch over to HFOV Shortening i-time will have what effect on systemic hemodynamics? improve systemic hemodynamics A sulcus sign on x-ray is associated with what? pneumothorax Pt's with kidney failure, in need of renal replacement therapy would benefit from what? veno-venous hemofiltration 3 key strategies in the management of refractory hypoxemia 1. reduce risk for oxygen toxicity 2. minimize alveolar stretch 3. reduce atelectrauma If system flush pressure on an arterial line system is too high, what will happen? pressure dampening The presence of serum protein in pleural fluid indicates what? exudate a central strategy in preventing VAP use of NIPPV, or early extubation to NIPPV If a patient has recently had a heart attack or is currently having a heart attack, what is MOST helpful in preserving cardiac tissue? therapeutic hypothermia protocol