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1. What is the most important sign in a critically ill pt? Why?
Answer: Tachypnea
Indicates metabolic acidosis w/ respiratory alkalosis compensation
2. A pt misses dialysis for a few days and comes in with fluid overload.
He's tachycardic and tachypneic. On physical exam, you find JVD, pulsus paradoxus (20
mmHg drop during inspiration), and HoTN (80/40) with distant, muffled heart sounds.
Lungs are clear to auscultation. What is the dx?
Answer: Cardiac tamponade; obstructive shock
3. If a pt has a thyromental distance of 2 cm, what can you expect about their
airway?
Answer: Difficult airway w/ an anteriorly displaced larynx
4. A COPD pt comes in with difficulty breathing. He then becomes apneic and
unresponsive. How would you ventilate this pt?
Answer: BVM
5. A pt arrives after falling from a ladder and has a frontal laceration. On ex- amination,
you find papilledema and labored breathing w/o being able to
1/7
,clear secretions. What is your biggest concern when intubating this pt?
Answer:
Cerebral edema/increasing ICP
Intubation tends to cause an increase in ICP. Administer lidocaine prior
to intubation to inhibit vagal stimulation.
6. An ESRD pt w/ hyperkalemia develops dyspnea and requires intubation.
Which paralytic agent/NMB should you avoid and why?
Answer:
Succinylcholine
Worsens hyperkalemia
7. A pt is admitted after an OD. He starts to have apneic episodes and his
SpO2 is dropping.You place him on a non-rebreather mask w/ 100% O2, ye his SpO2
remains at 80%. Why is it not being corrected?
Then, if you try a BVM and it also fails, and video laryngoscopy is
unavailable, what is your next best choice for an airway?
,Answer: The pt is having
apneic episodes, which means that administering high-flow O2 will be
ineffective.
Choose an LMA if the BVM fails.
8. What intervention improves outcomes with ROSC after cardiac arrest?
Answer:
Tar- geted temperature management.
32-36 C
9. A shunt means there is perfusion without ventilation. What disease
process is an example of a shunt?
Answer: Pneumonia
10. Which type of respiratory failure occurs with CNS depression after an OD?
Answer: Acute hypercapnic respiratory failure --> mixed
, 11. A 50 y/o pt is having a COPD exacerbation. You have tried steroids, bron-
chodilators, etc. with no improvement. PCO2 is in the 90s, pH is 7.20. You decide to
intubate. Vent settings are
Answer: VT 375, RR 20, FiO2 .35, PEEP 5. CXR is normal. A few minutes later, his BP
drops to 70/40. Lungs are clear/equal.
Vent shows peak airway pressure of 55 (high) and plateau pressure of 15. End expiratory
hold gives auto-peep of 15.
What is the cause of this pt's HoTN and why?
Answer: Auto-peep is the
cause. COPD pts have difficulty exhaling --> pressure buildup in
alveoli.
We use PEEP for the pressure and to improve oxygenation. Auto-peep
comes from breath-stacking --> intrinsic peep. Alveoli enlarge --> high
peak airway pressure. All leads to low venous return --> low CO -->
HoTN
12. A COPD pt is admitted to the ICU for exacerbation. Pt is on a vent. Pt is tx w/
bronchodilators, steroids, and Abx. ABG was normal 1 hr ago, but now the peak airway