FCCS (Fundamentals of Critical Care |\ |\ |\ |\ |\
Support) QUESTIONS WITH ANSWERS |\ |\ |\
What is the single most important indicator in critical illness?
|\ |\ |\ |\ |\ |\ |\ |\ |\
tachypnea
Beck's Triad |\
hypotension, JVD, muffled heart sounds |\ |\ |\ |\
- a/w cardiac tamponade
|\ |\ |\
What is the thyromental distance?
|\ |\ |\ |\
It is the distance in finger breadths between the anterior
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
prominence of the thyroid cartilage (adam's apple) and the tip of |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
the mandible (chin). It is an estimate of the length of the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
mandible and the available space anterior to the larynx |\ |\ |\ |\ |\ |\ |\ |\
What does it mean when the thyromental space is < 3
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
fingerbreadths?
- approx 6 cm
|\ |\ |\
- indicates the larynx might be more anterior and therefore
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
difficult to visualize during laryngoscopy |\ |\ |\ |\
** a more acute angulation of the stylet at the distal end of the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
endotracheal tube may be helpful. |\ |\ |\ |\
Patient is apneic w/ a pulse. What do you do?
|\ |\ |\ |\ |\ |\ |\ |\ |\
Bag them. |\
- One handed bag compressions should be delivered 10-20 times
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
per min. Each compression should take place over 1 second.
|\ |\ |\ |\ |\ |\ |\ |\ |\
,** If patient starts spontaneously breathing, try to be
|\ |\ |\ |\ |\ |\ |\ |\ |\
synchronous with their respiratory efforts. |\ |\ |\ |\
** If/once the patient is breathing easily and adequate Vt are
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
being inhaled, enough to produce minute ventilation, stop
|\ |\ |\ |\ |\ |\ |\ |\
bagging.
What is the goal of manual mask ventilation?
|\ |\ |\ |\ |\ |\ |\
to provide adequate minute ventilation: the product of the tidal
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
volume delivered during each resuscitation bag compression and
|\ |\ |\ |\ |\ |\ |\ |\
the number of compressions per min.
|\ |\ |\ |\ |\
** The total gas volume within most adult resus bags is 1 to 1.5
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
LITERS
Bag mask should be connected to ________% oxygen and flow at
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
a rate of _______
|\ |\ |\
100% oxygen at a rate of 15L/min |\ |\ |\ |\ |\ |\
HFNC
- Uses up to 100% oxygen source
|\ |\ |\ |\ |\ |\
- Provides higher amounts of FIO2 (0.32-1.0) in patients with high
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
minute ventilation requirements by matching patient's
|\ |\ |\ |\ |\ |\ |\
inspiratory demands and minimizing air dilution |\ |\ |\ |\ |\
- These devices also can generate PEEP (that is difficult to
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
measure; can cause barotrauma in theory) |\ |\ |\ |\ |\
- Flow rates up to 60L/min
|\ |\ |\ |\ |\
- heated and humidified oxygen
|\ |\ |\ |\
NRB
- AKA Reservoir Face Mask
|\ |\ |\ |\
- Bag is filled with 100% oxygen from a supply source (tank)
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
- The flow rate must be adjusted so that the bag remains
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
completely or partially distended throughout the respiratory cycle |\ |\ |\ |\ |\ |\ |\
- When the mask is properly applied, oxygen delivery can be
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
,maximized but rarely exceeds a FIO2 of 0.6 to 0.9 |\ |\ |\ |\ |\ |\ |\ |\ |\
- One way flap valves minimize entrapment of room air which
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
dilutes FiO2 |\
- NRB is a high oxygen high, flow device.
|\ |\ |\ |\ |\ |\ |\ |\
- non humidified oxygen
|\ |\ |\
** commonly used to improve oxygenation in patients with
|\ |\ |\ |\ |\ |\ |\ |\ |\
severe hypoxemia until further eval and treatments are
|\ |\ |\ |\ |\ |\ |\ |\
accomplished.
Aerosol Face Mask |\ |\
- This mask has large side holes, the mask itself is attached to
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
large bore tubing to a nebulize that blends 100% oxygen and
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
room air to deliver a PRESET FIO2 level (done by dial on oxygen
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
adapter)
- If the entire aerosol mist disappears from the mask during.
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
inhalation, the patient's inspiratory flow demands are probably
|\ |\ |\ |\ |\ |\ |\ |\
exceeding the capacity of the nebulizer and room air is being
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
entrained.
- minimum flow rate = 8L/min
|\ |\ |\ |\ |\
- Max FIO2 = 40-60%
|\ |\ |\ |\
- This is a variable oxygen, moderate-flow device.
|\ |\ |\ |\ |\ |\ |\
Simple Face Mask |\ |\
- minimum flow rate: 6L/min (to clear CO2 from mask)
|\ |\ |\ |\ |\ |\ |\ |\ |\
- humidified O2
|\ |\
- Approx. concentrations L to FIO2 ratios:
|\ |\ |\ |\ |\ |\
6L = 40%
|\ |\
7L = 50%
|\ |\
8L = 60%
|\ |\
Venturi Face Mask |\ |\
, - aka air entrainment face mask
|\ |\ |\ |\ |\
- delivers O2 through a jet mixing device that increases the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
velocity of oxygen and causes a controlled entrainment
|\ |\ |\ |\ |\ |\ |\
- the FiO2 can be more precisely controlled from .24 to .5 (24% to
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
50%) at high flow rates simply my selecting the interchangeable
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
nozzle and adjusting the O2 flow rate
|\ |\ |\ |\ |\ |\
- this is a high flow, controlled oxygen device.
|\ |\ |\ |\ |\ |\ |\ |\
Nasal Cannula flow rate to FIO2 estimates if RR and tidal volumes
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
are normal
|\ |\
1L |\ = |\ 24%
2L |\ = |\ 28%
3L |\ = |\ 32%
4L |\ = |\ 36%
5L |\ = |\ 40%
6L |\ = |\ 44%
NPPV uses two levels of positive airway pressure, combining
|\ |\ |\ |\ |\ |\ |\ |\ |\
modalities of pressure support ventilation and what? |\ |\ |\ |\ |\ |\
CPAP
What is CPAP? |\ |\
continuous positive airway pressure |\ |\ |\
- Allows spontaneous breathing from a gas source at an elevated
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
baseline system pressure (higher than atmospheric pressure)
|\ |\ |\ |\ |\ |\
- Functionally equivalent to PEEP.
|\ |\ |\ |\
By convention, PSV mode is referred to as _______ and CPAP is
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
referred to as _______ when talking about NPPV/BIPAP
|\ |\ |\ |\ |\ |\ |\
PSV = IPAP |\ |\
CPAP = EPAP |\ |\
The difference between these two numbers determines the tidal
|\ |\ |\ |\ |\ |\ |\ |\ |\
volume generated. |\
Support) QUESTIONS WITH ANSWERS |\ |\ |\
What is the single most important indicator in critical illness?
|\ |\ |\ |\ |\ |\ |\ |\ |\
tachypnea
Beck's Triad |\
hypotension, JVD, muffled heart sounds |\ |\ |\ |\
- a/w cardiac tamponade
|\ |\ |\
What is the thyromental distance?
|\ |\ |\ |\
It is the distance in finger breadths between the anterior
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
prominence of the thyroid cartilage (adam's apple) and the tip of |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
the mandible (chin). It is an estimate of the length of the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
mandible and the available space anterior to the larynx |\ |\ |\ |\ |\ |\ |\ |\
What does it mean when the thyromental space is < 3
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
fingerbreadths?
- approx 6 cm
|\ |\ |\
- indicates the larynx might be more anterior and therefore
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
difficult to visualize during laryngoscopy |\ |\ |\ |\
** a more acute angulation of the stylet at the distal end of the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
endotracheal tube may be helpful. |\ |\ |\ |\
Patient is apneic w/ a pulse. What do you do?
|\ |\ |\ |\ |\ |\ |\ |\ |\
Bag them. |\
- One handed bag compressions should be delivered 10-20 times
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
per min. Each compression should take place over 1 second.
|\ |\ |\ |\ |\ |\ |\ |\ |\
,** If patient starts spontaneously breathing, try to be
|\ |\ |\ |\ |\ |\ |\ |\ |\
synchronous with their respiratory efforts. |\ |\ |\ |\
** If/once the patient is breathing easily and adequate Vt are
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
being inhaled, enough to produce minute ventilation, stop
|\ |\ |\ |\ |\ |\ |\ |\
bagging.
What is the goal of manual mask ventilation?
|\ |\ |\ |\ |\ |\ |\
to provide adequate minute ventilation: the product of the tidal
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
volume delivered during each resuscitation bag compression and
|\ |\ |\ |\ |\ |\ |\ |\
the number of compressions per min.
|\ |\ |\ |\ |\
** The total gas volume within most adult resus bags is 1 to 1.5
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
LITERS
Bag mask should be connected to ________% oxygen and flow at
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
a rate of _______
|\ |\ |\
100% oxygen at a rate of 15L/min |\ |\ |\ |\ |\ |\
HFNC
- Uses up to 100% oxygen source
|\ |\ |\ |\ |\ |\
- Provides higher amounts of FIO2 (0.32-1.0) in patients with high
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
minute ventilation requirements by matching patient's
|\ |\ |\ |\ |\ |\ |\
inspiratory demands and minimizing air dilution |\ |\ |\ |\ |\
- These devices also can generate PEEP (that is difficult to
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
measure; can cause barotrauma in theory) |\ |\ |\ |\ |\
- Flow rates up to 60L/min
|\ |\ |\ |\ |\
- heated and humidified oxygen
|\ |\ |\ |\
NRB
- AKA Reservoir Face Mask
|\ |\ |\ |\
- Bag is filled with 100% oxygen from a supply source (tank)
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
- The flow rate must be adjusted so that the bag remains
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
completely or partially distended throughout the respiratory cycle |\ |\ |\ |\ |\ |\ |\
- When the mask is properly applied, oxygen delivery can be
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
,maximized but rarely exceeds a FIO2 of 0.6 to 0.9 |\ |\ |\ |\ |\ |\ |\ |\ |\
- One way flap valves minimize entrapment of room air which
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
dilutes FiO2 |\
- NRB is a high oxygen high, flow device.
|\ |\ |\ |\ |\ |\ |\ |\
- non humidified oxygen
|\ |\ |\
** commonly used to improve oxygenation in patients with
|\ |\ |\ |\ |\ |\ |\ |\ |\
severe hypoxemia until further eval and treatments are
|\ |\ |\ |\ |\ |\ |\ |\
accomplished.
Aerosol Face Mask |\ |\
- This mask has large side holes, the mask itself is attached to
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
large bore tubing to a nebulize that blends 100% oxygen and
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
room air to deliver a PRESET FIO2 level (done by dial on oxygen
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
adapter)
- If the entire aerosol mist disappears from the mask during.
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
inhalation, the patient's inspiratory flow demands are probably
|\ |\ |\ |\ |\ |\ |\ |\
exceeding the capacity of the nebulizer and room air is being
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
entrained.
- minimum flow rate = 8L/min
|\ |\ |\ |\ |\
- Max FIO2 = 40-60%
|\ |\ |\ |\
- This is a variable oxygen, moderate-flow device.
|\ |\ |\ |\ |\ |\ |\
Simple Face Mask |\ |\
- minimum flow rate: 6L/min (to clear CO2 from mask)
|\ |\ |\ |\ |\ |\ |\ |\ |\
- humidified O2
|\ |\
- Approx. concentrations L to FIO2 ratios:
|\ |\ |\ |\ |\ |\
6L = 40%
|\ |\
7L = 50%
|\ |\
8L = 60%
|\ |\
Venturi Face Mask |\ |\
, - aka air entrainment face mask
|\ |\ |\ |\ |\
- delivers O2 through a jet mixing device that increases the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
velocity of oxygen and causes a controlled entrainment
|\ |\ |\ |\ |\ |\ |\
- the FiO2 can be more precisely controlled from .24 to .5 (24% to
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
50%) at high flow rates simply my selecting the interchangeable
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
nozzle and adjusting the O2 flow rate
|\ |\ |\ |\ |\ |\
- this is a high flow, controlled oxygen device.
|\ |\ |\ |\ |\ |\ |\ |\
Nasal Cannula flow rate to FIO2 estimates if RR and tidal volumes
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
are normal
|\ |\
1L |\ = |\ 24%
2L |\ = |\ 28%
3L |\ = |\ 32%
4L |\ = |\ 36%
5L |\ = |\ 40%
6L |\ = |\ 44%
NPPV uses two levels of positive airway pressure, combining
|\ |\ |\ |\ |\ |\ |\ |\ |\
modalities of pressure support ventilation and what? |\ |\ |\ |\ |\ |\
CPAP
What is CPAP? |\ |\
continuous positive airway pressure |\ |\ |\
- Allows spontaneous breathing from a gas source at an elevated
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
baseline system pressure (higher than atmospheric pressure)
|\ |\ |\ |\ |\ |\
- Functionally equivalent to PEEP.
|\ |\ |\ |\
By convention, PSV mode is referred to as _______ and CPAP is
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
referred to as _______ when talking about NPPV/BIPAP
|\ |\ |\ |\ |\ |\ |\
PSV = IPAP |\ |\
CPAP = EPAP |\ |\
The difference between these two numbers determines the tidal
|\ |\ |\ |\ |\ |\ |\ |\ |\
volume generated. |\
