FCCS Post Test Exam Questions And Well Elaborated Solutions

FCCS Post Test Exam Questions And Well Elaborated Solutions In AG metabolic acidosis it's used. It tells you if there's underlying metabolic alkalosis or respiratory acidosis with bicarb compensation IN ADDITION to the AG metabolic acidosis. Both of those would result in a high bicarb to begin with, and a smaller change in bicarb from normal. Winter's formula (equation, what it measures) - answers 1.5[HCO3] + 8 +/- 2 If compensation is adequate in acid/base issues How AG changes with albumin changes - answers Decreases 2.5-3 for every 1 decrease in albumin Hemodynamic changes after intubation - answers Hypo/hypertension Arrhythmia Tachycardia Pressure support equation for BiPAP - answers IPAP - EPAP 3 types of vent cycles - answers Volume (preset tidal volume, relieves WOB the most) Time (constant pressure of time) Flow (constant pressure until inspiratory flow is below 25% of peak) Goal tidal volume - answers 10 cc/kg Goal FiO2 on vent - answers Start at 1.0, then decrease as SpO2 tolerates (goal of 92-94 saturation) Ppeak - answers Peak inspiratory pressure Pplat (try to keep it below ?) - answers Inspiratory plateau pressure (shows alveolar distention) 30 AutoPEEP (what it is, what it causes, how to fix it) - answers Breath stacking Decreases preload to the heart with positive pressure on the lungs --> hypotension Decrease RR, decrease inspiration time (goal is to have more time for the lungs to exhale) Danger of increased PEEP - answers Increases autoPEEP, increases Pplat PaO2 we're usually happy with - answers >60 When to consider NPPV vs invasive - answers When it's a quickly solved problem in 1-2 days (e.g. COPD exacerbation) When the patient can be compliant with working with NPPV When to consider switching from NPPV to invasive ventilation support - answers If things aren't really improving in a matter of hours If your therapeutic goals haven't been met in 4-6 hours Manual decompression (when you use it) - answers If patient is air trapping like crazy on the vent, and you disconnect it and push up on the patients diaphragm to get everything out What a high A-a gradient means - answers V/Q mismatch Volume assist-control breath (Volume cycled) - answers Vent delivers preset tidal volume Pressure assist-control breath (time cycled) - answers Vent delivers a constant pressure over a preset time Pressure support breath (flow cycled) - answers Same as pressure assist-control breaths, but the vent cuts out when the flow rate decreases to 25% of initial peak flow rate Assist-control ventilation - answers Either volume or time cycled breaths given Usually the go to when you just started someone on the vent Gives the pt a set tidal volume and preset flow rate respiratory rate. Very rigid. However, if the patient wants to take extra breaths if they trigger them. Pressure support ventilation - answers Waits for patient to start breath, and then helps out with a set amount of pressure Synchronized intermittent mandatory ventilation - answers SIMV Delivers volume or time cycled breaths at a mandatory rate Patient can breathe spontaneously between mandatory breaths Spontaneous breaths count - this allows the patient to contribute to the mandatory tidal volume the machine requires them to breathe When do you give tPA in ACS? - answers ONLY for a STEMI, and ONLY when PCI isn't readily available Tx of an inferior MI - answers NO nitroglycerin Give fluids instead ABG findings in PE - answers Decreased CO2 (hyperventilating) Decreased O2 (V/Q mismatch) Most important indicator that a patient has a severe illness? - answers Tachypnea 3 respiratory types, and their criteria - answers Hypoxemic (PaO2 <50-60) Hypercapnic (PaCO2 >50, pH <7.36) Mixed Delta gap (formula, when and why it's used) - answers Difference in AG from normal - Difference in HCO3 from normal When to give tPA in PE - answers Only for huge ones and heparin's not working Lovenox class - answers LMWH Airway in hematemesis pt - answers Electively intubate it Tx of HTN urgency vs emergency - answers No drip vs drip Intraabdominal HTN (criteria, effects) - answers >12 mmHg End organ damage and decreased preload to heart causing hypotension CPP goal in TBI (and how to calculate it) - answers 50-70 MAP - ICP SAH tx - answers nimodipine to stop vasospasm and control BP Sepsis vs severe sepsis vs septic shock - answers You know vs End organ damage vs Resistant to tx CAP tx - answers beta-lactam and macrolide OR fluoroquinolone HCAP tx - answers vanc/zosyn CAP immunocompromised pt (tx) - answers Bactrim Endocarditis bugs - answers Strep viridans and other streps, staph SBP abx - answers ceftriaxone flagyl Pregnancy pyelo tx - answers ceftriaxone Necrotizing fasciitis tx - answers vanc/zosyn clindamycin Neutropenic fever abx - answers Think G-, so cefepime