Kettering TMC Exam C |2026/2027 Update | Verified Questions & Answers | 100% Pass Guarantee | A+ Grade

Kettering TMC Exam C |2026/2027 Update | Verified Questions & Answers | 100% Pass Guarantee | A+ Grade Q: Which of the following statements is consistent with a high-quality radiographic image? 1. Head of clavicles are level. 2. Spaces between vertebrae are distinct. 3. Lung parenchyma appear black and without blood vessels. 4. Cervical vertebral spaces are smaller than thoracic vertebral spaces. Answer 1 and 2 only Q: An elevated brain natriuretic protein (BNP) level would be consistent with a diagnosis of.... Answer Congestive Heart Failure Q: While monitoring the pressure waveform during insertion of a Swan-Ganz catheter, the RT notes the presence of a dicrotic notch. This finding indicates that the tip of the catheter is inside the.... Answer Pulmonary Artery Q: The RT has measured the exhaled nitric oxide concentration (FENO) of a patient with asthma. The therapist notes a decrease in the patient's FENO levels from his last visit one month ago. These results would be consistent with increased use of.... Answer Corticosteroids Q: The RT discovers that a patient has dyspnea and diminished breath sounds with a flat percussion note on the left. The chest radiograph indicates a tracheal shift to the right. What disease state should the therapist suspect is affecting the patient? Answer Pleural Effusion Q: A patient is being monitored with a pulmonary artery catheter. The following measurements are recorded: Answer CVP: 4 mmHg Mean PAP: 18 mmHg MAP: 84 mmHg Cardiac Output: 4 L/min Q: What is the patient's systemic vascular resistance? Answer (MAP-CVP) / Cardiac Output (84 - 4) / 4 80/4 = 20 Convert to dynes: multiply answer by 80 20 x 80 = 1,600 dynes/s/cm Q: A 32-week gestation age infant is receiving mechanical ventilation with a time cycled, pressure-limited ventilator at the following settings: Answer SIMV PIP: 28 cmH2O RR: 22/min FiO2: 60% PEEP: 6 Flow: 6 l/min I-time: 0.6 seconds Q: The RT notices the TcPO2 reading suddenly drops 39 torr. There have been no changes in the vent settings, however the patient is cyanotic, the trachea is deviated to the right and the breath sounds are absent on the left. A tympanic percussion note is detected over the left thorax. The RT should recommend what? Answer Transillumination to detect a pneumothorax Q: Following insertion of a nasal endotracheal tube, the RT should inflate the cuff to: Answer 22 mmHg Q: Which suction catheter would be most appropriate to use for a patient with a size 7.5 mm ID ETT? Answer (ID size / 2) x 3 7.5/2= 3.75 x 3 = 11.25 Round down to 10 Fr Q: While manually ventilating a 42-year-old woman following endotracheal intubation, the RT notices that the manual resuscitation bag fills rapidly and collapses with minimal pressure. The therapist also observes that the patient's chest has limited bilateral movement. The therapist should... Answer Use another form of ventilation. Q: What is the most appropriate position for an obese patient with dyspnea? Answer Lateral Fowlers Q: While administering IPPB therapy to a 58-year-old man who recently underwent a colon resection, the RT notes that the peak inspiratory pressure is not reaching the set value. This is most likely the result of.... Answer insufficient inspiratory flow Q: After attaching a bubble humidifier to an O2 flowmeter, setting the flow at 5 L/min, and occluding the humidifier outlet, the RT hears a whistling sound from the humidifier. This would indicate.... Answer proper function of the humidifier Q: A patient suffering from carbon monoxide poisoning is receiving 100% O2 via non rebreather mask at a set O2 flow of 15 L/min. Each time the patient inhales, the reservoir bag on the mask remains fully inflated. The therapist should Answer seal the mask against the patient's face Q: What value for oxygenation index would indicate the need for ECMO in a newborn? Answer 44 Q: A 44-year-old male has been admitted to the hospital after being involved in a sky diving accident. He is 193 cm (6ft 4 in) tall and weighs 82 kg (182 lbs). The patient has been orally intubated with a size 8.5 ETT. A CXR reveals bilateral opacification of all lung fields. Mechanical ventilation has been established with a volume ventilator at the following settings: Answer Mode: VC, SIMV Vt: 650 mL RR: 12/min FiO2: 0.65 PEEP: 10 PIP: 58 Plat: 50 ABG: pH 7.30, PaCO2 43, PaO2 45, HCO3 21, SaO2 82% The patient's condition is most likely related to: Venous admixture Q: Estimate the shunt fraction for a patient with the following available data: Answer A-aDO2: 200 torr C(a-v)O2: 3.6 vol% P/F Ratio: 400 torr For each 100 mmHg in A-a, a 5% shunt occurs. Add 5% more to that answer (due to normal shunting). 200 torr = 10% + 5% = 15% shunt Q: An 80kg (176 lb) patient in the post-anesthesia care unit following lower abdominal surgery is receiving mechanical ventilation. Ventilator settings are as follows: Answer VC, SIMV Vt: 550 mL f: 15/min FiO2: 70% PEEP: 15 ABG: pH 7.35, PaCO2 44 torr, PaO2 85 torr, HCO3 23, SaO2 99%, C(a-v)O2 10 vol% The RT should: Reduce the PEEP setting. Q: In preparation for assisting a pulmonologist with a fiberoptic bronchoscopy for a 50-year-old woman receiving mechanical ventilation, the RT notices that the patient appears to be anxious about undergoing the procedure. The therapist should recommend administration of: Answer Midaxolam Q: The parameter that starts the inspiratory phase of a positive pressure breath is referred to as the Answer trigger variable Q: While evaluating a patient receiving mechanical ventilation, the RT observes a persistent high pressure alarm. What could cause that situation? Answer Excessive secretions Q: What would be the most appropriate initial ventilator settings for a patient recently intubated for myasthenia gravis? The patient is 178cm (5'10") and weighs 70 kg. A. PC, SIMV; PIP 50 cm H2O, f 8/min, FiO2 .50, PEEP 2 B. VC, AC; Vt 550 mL, f 15/min, FiO2 0.50, 4 cm H2O PEEP C. PC, AC; PIP 30 cmH2O, f 12/min, FiO2 0.65, PEEP 3 D. VC, SIMV; Vt 600 mL; f 13/min, FiO2 45%, PEEP 10 Answer B: VC, AC; Vt 550 mL, f 15/min, FiO2 50%, PEEP 4 Q: An 80 kg (176 lb) patient in the ICU following aortic valve replacement surgery is receiving mechanical ventilation. Vent settings are as follows: Answer VC, SIMV; Vt 550mL; f 15/min; FiO2 65%; PEEP 5 ABG: pH 7.26; PaCO2 54 torr; PaO2 65 torr; HCO3 24; SaO2 89%; C(a-v)O2 4.5 vol% The RT should Increase the frequency Q: Side effects of inhaled nitric oxide include: Answer Methemoglobinemia, formation of nitrogen dioxide Q: A patient with a left-sided pneumothorax has been treated with a chest tube attached to a 3-bottle water seal drainage system. The RT notes continuous bubbling in the suction control bottle. This would indicate: Answer Correct setting of the vacuum regulator Q: A 55-year-old, 90 kg man is undergoing polysomnography. The RT observes that the patient continues to have obstructive apneic events on nasal CPAP at 4 cmH2O. The therapist should.... Answer increase the CPAP pressure Q: A 70-year-old woman with COPD is receiving home O2 therapy at 2 L/min via NC. The O2 is provided by a molecular sieve device. The patient calls the equipment provider to report that she does not feel any O2 coming out of the cannula. This situation could be caused by all of the following EXCEPT: A. a power interruption B. disconnected tubing C. low water level in the humidifier D. incorrect flow setting Answer C. low water level in the humidifier Q: After analyzing an arterial blood sample, the RT drops the syringe on the lab counter and 4 mL of blood leaks out. After wiping up the blood with a paper towel, the therapist should disinfect the counter using Answer a bleach solution. Q: Pack years Answer # of packs a day x # of years smoked Q: If intake of fluid exceeds output, this could result in Answer weight gain electrolyte imbalance increased hemodynamic pressures decreased lung compliance Cheyne-Stokes Answer Gradually increasing then decreasing rate and depth in a cycle lasting from 30 - 180 seconds, with periods of apnea lasting up to 60 seconds. Causes: increased ICP, brainstem injury, drug overdose Tracheal deviation toward pathology (inside the lung) Answer - pulmonary atelectasis - pulmonary fibrosis - pneumonectomy - diaphragmatic paralysis Tracheal deviation away from pathology (outside of lung) Answer - massive pleural effusion - tension pneumothorax - neck or thyroid tumors - large mediastinal mass Egophony Answer The patient is instructed to say "E" and it sounds like "A". This would indicate consolidation of the lung tissue as with a pneumonia-like condition. Abnormal breath sounds Answer Adventitious Coarse Crackles Answer Large airway secretions - suction patient or instruct to cough Medium Crackles Answer Recommend bronchial hygiene Fine Crackles Answer Fluid at the alveolar level (associated with CHF or pulmonary edema) - O2 therapy - positive pressure therapy - positive inotropic agents - diuretics Stridor- Answer Upper airway obstruction - supraglottic swelling (epiglottitis) - subglottic swelling (croup) - foreign body aspiration Treat with racemic epinephrine Lateral decubitus Answer - patient lying on affected side - valuable for detecting small pleural effusions Pacemaker position Answer right ventricle Pulmonary artery catheter position Answer should appear in the right lower lung field Central Venous catheter position Answer inserted through the subclavian or jugular vein and should rest in the superior vena cava or right atrium of the heart (4th intercostal space, right of sternum) Nasogastric tubes/feeding tubes position Answer in the stomach 2 - 5 cm below the diaphragm Radiolucent Answer - dark pattern, air normal for lungs Radiodense/opacity White pattern, solid, fluid Normal for bones, organs Infiltrate Any ill-defined radiodensity Atelectasis Consolidation Solid white area Pneumonia/pleural effusion Hyperlucency Extra-pulmonary air COPD, asthma attack, pneumothorax Vascular markings lymphatics, vessels, lung tissue Increased in CHF, absent with pneumothorax Diffuse spread throughout atelectasis/pneumonia Opaque fluid/solid consolidation Pulmonary Edema - fluffy infiltrates, butterfly pattern, batwing pattern - diffuse whiteness - diuretics, digitalis, digoxin Atelectasis - patchy or plate-like infiltrates, crowded pulmonary vessels, crowded air bronchograms - scattered, thin-layered densities - lung expansion therapy ARDS or IRDS - ground glass appearance, honeycomb pattern, diffuse bilateral radiopacity - reticulogranular, reticulonodular - O2 therapy, Low Vt or PIP, CPAP, PEEP Pleural Effusion - blunting/obliteration of costophrenic angle, basilar infiltrates with meniscus, concave superior interface/border - fluid level on affected side, possible mediastinal shift to unaffected side - thoracentesis, chest tube, antibiotics, steroids Pneumonia - air bronchogram - increased density from consolidation and atelectasis - antibiotics Pulmonary Embolus - peripheral wedge-shaped infiltrate - may not be immediately detected on CXR - heparin, streptokinase Tuberculosis What is a Computed Tomography (CT) Scan useful in detecting? - presence of mediastinal, pleural and parenchymal masses - pulmonary nodules and lesions not visualized on CXR What is Magnetic Resonance Imaging (MRI) useful in detecting? thoracic aneurysms, congenital anomalies of the aorta and major thoracic vessels Pulmonary Ventilation/Perfusion Scan (V/Q Scan) A normal ventilation scan with an abnormal perfusion scan indicates a pulmonary embolus. Positron Emission Tomography (PET Scan) Useful in determining the presence of cancer, brain disorders and heart disease Bronchography (Bronchogram) By outlining the airways it will identify obstructing lesions (i.e. tumors) and bronchiectasis (main indication) Indications for EEG Brain tumors, traumatic brain injuries, loss of brain function, epilepsy/seizures, evaluation of sleep disorders Pulmonary Angiography A pulmonary arteriogram or angiograph is a test to diagnose a pulmonary embolism Indications: high clinical suspicion for PE; inconclusive V/Q scan and/or CT scan Indications for Echocardiogram (Ultrasound of the heart) Valvular disease or dysfunction; myocardial disease; abnormalities of cardiac blood flow; cardiac anomalies in the infant; abnormal heart sounds Intracranial Pressure (ICP) monitoring Normal is 5 - 10 mmHg - recommend initiating treatment if 20 mmHg - therapy to reduce ICP: hyperventilation: target PaCO2 = 25 - 30 torr Electrolytes: K+, Na+, Cl, HCO3 (CO2 content) - Elements required by the body for normal metabolism - Abnormal electrolyte levels indicate abnormal body function - Closely associated with fluid levels, muscle function (cardiac) and kidney function - muscle weakness, soreness, nausea, mental changes, lethargy, dizziness Potassium (K+) - major intracellular cation - Important for acid-base balance and muscle function, including cardiac muscle - Hypokalemia refers to low K+; occurs with metabolic alkalosis, excessive excretion, vomiting, flattened T waves on ECG - Hyperkalemia = kidney failure, spiked T wave, metabolic acidosis Sodium (Na+) - major extracellular cation controlled by kidneys Hyponatremia: fluid loss from diuretics, vomiting, diarrhea, fluid gain from CHF, IV therapy Hypernatremia: dehydration Na+ is retained in exchange for K+ Chloride (Cl-) major extracellular anion Levels are closely associated with Na+ - Hypochloremia = metabolic alkalosis - Hyperchloremia = metabolic acidosis Activated Partial Thromboplastin Time (APTT) - measures the length of time required for plasma to form a fibrin clot - used for monitoring heparin therapy Prothrombin Time - Used for monitoring Warfarin (Coumadin) therapy SHORTCUT QRS looks like an upside-down V - problem with QRS = problem with Ventricles SHORTCUT RBC norm = 5 ---- 5 x 3 = 15 Hb norm is 15 ---- 15 x 3 = 45 Hct norm is 45! Axis The axis of an ECG measures the net direction of all the electricity through the heart during contraction. - normally the electrical impulse begins in the upper right corner of the heart (SA node, right atrium) and moves in waves down across the heart to the left - Normal axis direction is DOWN and to the LEFT Hypertrophy increase in electrical activity of the heart; axis will shift toward hypertrophy Infarction dead heart tissue, no electrical activity - axis will shift away from infarction How do you estimate HR on an ECG strip? Heart rate = 300 / # of large boxes between R waves Ischemia reduced blood flow to tissue - indicated by a depressed or inverted T wave Injury acute damage to tissue (often from ischemia) - indicated by an elevated S-T segment APGAR Scoring Good - 2; Bad - 1; Very Bad - 0 0-3: Resuscitate 4-6: Support - stimulate, warm, administer O2 7-10: Monitor - routine care Bad Score: body pink, extremities blue; 100 beats/min; grimace reflex; some flexion of extremities; slow, irregular weak cry Normal vitals - INFANT temp: 36.5 *C HR: 110 - 160 bpm (faster in preterm) RR: 30 - 60 breaths/min (higher in preterm) BP: 60/40 mmHg (50/30 preterm) Weight: 3000 g (6lbs) Silverman Score Assessment of respiratory distress in the infant - Score 0 - 10 - Higher the score, greater the distress Dubowitz or Ballard Method Assesses gestational age - higher the score, higher the gestational age in weeks New Ballard Score Estimates gestational age in very low birth weight infants If the pre-ductal (right radial artery) PaO2 is 15 torr+ higher than the post-ductal (umbilical artery) PaO2 then... the patient has a patent ductus arteriosus with a right to left shunt Lecithin/Sphingomyelin (L/S) Ratio A ratio of 2:1 or higher is good - incidence of IRDS would approach zero - recommend surfactant replacement therapy if lower than 2:1 Phosphatidylglycerol (PG) Phospholipid appearing at about 36 weeks gestation and rising until term - most reliable indicator of pulmonary maturity - only performed on amniotic fluid Capnography Monitoring of exhaled carbon dioxide - sensor should be placed proximal to patient's airway - normally PETCO2 reads lower than PCO2 - an increase would indicate a decrease in ventilation - a decrease would indicate an increase in ventilation or decreased perfusion (deadspace disease, pulmonary embolism, hypovolemia) Co-oximeter/Hemoximeter Used to diagnose carbon monoxide poisoning - CO poisoning 20% Transcutaneous PO2 and PCO2 measurement Electrode site should be changed every four hours. If redness or blistering of the skin (erythema) occurs the electrode should be moved to a new site more often. - Air leaks will increase the TcPO2 to read higher than the PaO2 Three factors that control blood pressure Heart: pump that creates BP. Chronotropic drugs increase the HR, inotropic drugs increase contractility. Blood: the amount of fluid (blood) in the circulatory system will affect the BP Vessels: the condition of the blood vessels will cause the blood pressure to change. Four heart chambers and the circulatory branches they serve Left Ventricle: systemic arteries Right Atrium: systemic veins Right Ventricle: pulmonary arteries Left Atrium: pulmonary veins If the dicrotic notch is seen, the pulmonary artery catheter is in the pulmonary artery Troubleshooting for Artery Catheters - If while monitoring PAP you are unable to see distinct high and low values (systolic and diastolic pressures) check to see if the balloon is deflated Oral intubation tube distance 21 - 25 cm mark at patient's lips Nasal intubation tube distance 26 - 29 cm mark at patient nare Vacuum Pressures Adult: 100 - 120 mmHg Child: 80 - 100 mmHg Infant: 60 - 80 mmHg The external diameter of the suction catheter should be... no greater than 1/2 the inside diameter (ID) of the endotracheal or trach tube - Catheter Size = (ID size/2) x 3 Patient positioning based on pathology Prone - ARDS Fowler's - CHF Lateral Fowler's - obese Good lung down for unilateral disease Low flow devices Nasal Cannula - FiO2 25-45%; 1 - 6 L/min; most appropriate for COPD patients with stable RR and Vt Simple Mask: FiO2 40 - 55%; 6 - 10 L/min Partial Rebreather Mask: FiOw 60-65%; 6 - 10 L/min; High flow devices Non-rebreather: FiO2 21-100%; used to deliver 100% O2 in an emergency (pneumothorax, CO poisoning, CHF, burns, etc.) Air Entrainment Mask (Venturi Mask): delivers precise FiO2 concentrations (ideal for COPD) Accuracy of flowmeter can be verified with rotameter or calibration flowmeter differential pressure transducer (pneumotach) Duration of Cylinder Flow Duration (in min) = gauge pressure (psi) x tank factor/liter flow E cylinder: 0.28 L/psi (0.3) H cylinder: 3.14 L/psi (3.0) Effect of air bubbles on ABG PaCO2 decreases toward 0 torr PaO2 increases or decreases toward 150 torr pH increases Effect of improper ABG sample cooling PaCO2 increases PaO2 decreases pH decreases Effect of too much liquid heparin in ABG PaCO2 decreases toward 0 PaO2 decreases pH decreases toward 7.0 Blood Gas Analyzing Each control solution should be run at least once per day Values should remain within 2 standard deviations of the mean. Point of Care Testing Any type of lab testing done at the bedside PAO2 shortcut formula PAO2 = (FiO2 x 7) - (PaCO2 + 10) P/F Ratio PaO2 / FiO2 - Normal value is 380 torr or greater - A ratio less than 300 torr signifies ALI - A ratio less than 200 torr signifies ARDS PaCO2 35 - 45 torr Normal Ventilation: - don't change vent settings - don't put the patient on mechanical ventilation PaCO2 above 45 Patient is NOT ventilating - Initiate ventilation or remove/decrease mechanical deadspace or increase current ventilation PaCO2 below 35 Patient is ventilating too much - don't put the patient on mechanical ventilation - decrease ventilation (if PaO2 is high) or consider other causes of hyperventilation (hypoxemia, metabolic acidosis, etc.) PaO2 value below 80 (Hypoxemia) FiO2 .21 - .59 Hypoxemia can be caused by: 1. Poor ventilation (high PaCO2) 2. V/Q mismatch (normal or low PaCO2) - increase ventilation; increase FiO2 up to .60 PaO2 below 80; FiO2 60%+ Shunt, refractory hypoxemia, venous admixture - start or increase CPAP or PEEP - CPAP: patient is breathing spontaneously - PEEP: patient is on ventilator PaO2 above 100 (Hyperoxemia) FiO2 22-100% Decrease FiO2, PEEP, or CPAP - decrease the FiO2 first if at or about 60%. Once below 60%, then reduce PEEP/CPAP. A Respiratory acidosis or alkalosis occurs when... the pH is abnormal because of a change in the PCO2 A Metabolic acidosis or alkalosis occurs when... the pH is abnormal because of a change in the HCO3 A partial compensation occurs when.... the pH is out of normal range and both CO2 and HCO3 are changing in the same direction Finding personal best on peak flow meter Instruct the patient to record their peak flow every day, morning and afternoon, for two to three weeks during a period when their asthma is under control. - the single highest measurement recorded during this timeframe is their personal best Vital Capacity Decreased volumes indicate Restrictive Disease Decreased Vital Capacity is the best indicator of Restrictive lung disease Forced Vital Capacity The volume that can be expired as forcefully and rapidly as possible after a maximum inspiration. - provides the flow rates used to identify obstructive disease If the FEV1 is decreased but the FEV1/FVC ratio is normal, then the patient has restrictive disease only Forced Expiratory Flow 200 - 1200 (FEF) decreased values are associated with large airway obstruction FEF 25-75 decreased values are associated with small airway obstruction Maximum Voluntary Ventilation (MVV) - measures the muscular mechanics of breathing - decreased with obstructive disease, increase airway resistance (Raw), muscle weakness, decreased compliance, and poor patient effort FRC Measurement Helium Dilution (Closed Method) - a known concentration of helium is diluted by the patient's FRC - the change in the concentration is used to determine the FRC Nitrogen Wash Out (Open method) - The FRC is washed out of the lung by having the patient inspire 100% O2 to replace the nitrogen in the FRC - the amount of nitrogen removed is used to calculate the FRC Trigger Variable the parameter that starts the inspiratory phase of a positive pressure breath Control or Target Variable the primary variable the vent adjusts to achieve inspiration Limit variable establishes a maximum value that a variable (pressure, volume, time, flow) can reach during inspiration Cycling Variable the variable that ends the inspiratory phase of a positive pressure breath Volume Cycle Pressure is applied to the airways until a preset volume is delivered - Advantage: minute volume will remain constant to provide stable blood gases - Disadvantage: as lung compliance or airway resistance worsen: 1. PIP and Plat increase 2. May result in barotrauma or volutrauma Pressure Cycled Positive pressure is applied to airways until a preset pressure value is reached. - Vt may be adjusted by increasing or decreasing the pressure. Time Cycled Apply positive pressure until a preset time is reached. Flow Cycled Positive pressure is applied to the airway until a predetermined flow is achieved. Three phases of mechanical ventilation 1. Recommend/initiate mechanical ventilation and initial settings 2. Monitor patient receiving mechanical ventilation; recommend/initiate changes to vent settings; identify and correct problems with the patient and/or vent 3. Assess patient's readiness for weaning; implement weaning procedures; monitor patient during weaning Indications for mechanical ventilation Apnea (absolute indication) Acute ventilatory/respiratory failure Impending ventilatory failure - trend of rising PaCO2 and/or decreasing Vt, VC, MIP If a patient has an acceptable PaCO2, oxygenation.... can be supported with O2 therapy and CPAP Initial Mechanical Ventilation Settings - Any mode is acceptable for initial setup - Vt: 5 - 10 mL/kg of IBW - Pressure: Plat from VC, or to achieve target Vt, or less than or equal to 35 cmH2O - RR: 10 - 20 breaths/min - FiO2 (patient on room air/no prior info): 40 - 60% (patient currently on O2): set at same level PEEP (no prior info): 2 - 6 cmH2O (patient on CPAP): set at same level Initial Mechanical Ventilation Settings (INFANT) Vt: 4 -6 mL/kg PIP: 20 - 30 cmH2O RR: 20 -30 breaths/min FiO2 (no prior info): 40 - 60% (currently on O2): set at same level PEEP (no prior info): 2-4cmH2O (CPAP): set at same level Dynamic Compliance Vt / PIP - PEEP Static Compliance Vt / Plat - PEEP Minute Ventilation (VE) = (Vt x f) Assist Control The vent will deliver a minimum number of mandatory breaths each minute. Synchronous Intermittent Mandatory Ventilation (SIMV) Vent provides a minimum number of mandatory breaths each minute - Used for patients with tachypnea to avoid hyperventilation - May achieve lower mean airway pressure than with A/C - Used with PEEP to reduce barotrauma Inverse Ratio Ventilation (IRV) Pressure or volume controlled breaths with an inverse I:E ratio - improves oxygenation and gas exchange; decreases PIP and PEEP levels Airway Pressure Release Ventilation (APRV) Same as Bi-Pap - a form of spontaneous breathing at a positive pressure level; similar to CPAP Pressure Regulated Volume Control (PRVC) A form of ventilation that keeps pressure at the lowest level by providing automatic, breath to breath pressure regulation while providing a preset volume Increasing airway pressures Indicates that the lung is becoming more difficult to ventilate Two reasons for airway pressure to increase during mechanical ventilation: Increasing Airway Resistance - frictional force that must be overcome during breathing - normal airway resistance is 0.6 - 2.4cmH2O (for intubated patient, may be as high as 6 cmH2O) - secretions in airway or bronchospasm Decreasing Lung Compliance - Atelectasis, pulmonary edema, ARDS, pneumonia - increase PEEP; treat underlying cause Priorities when you have an emergency: - First priority is ventilation - Second priority is oxygenation - Third priority is circulation - Fourth priority is perfusion - consider especially when interpreting a blood gas Bronchial breath sounds over lung periphery would indicate.... lung consolidation Unilateral wheeze indicative of.... foreign body obstruction The tip of the ETT should be 2 - 6 cm above the carina Exhaled Nitric Oxide (FEno) Testing - measurement of nitric oxide concentration in patient's exhaled breath - used to monitor patient's response to corticosteroid treatment - a decrease in FEno suggests a decrease in airway inflammation - measured using handheld device Exhaled Carbon Monoxide (FEco) Testing - exhaled CO easily measured with small, portable device - can be used to monitor abstinence in cigarette smokers Hypokalemia Hyperkalemia Low K+ - excessive vomiting, exretion, flattened T waves on ECG High K+; kidney failure; spiked T waves Chest electrode placement V1: 4th intercostal space on right side of sternum V2: 4th intercostal space on left side of sternum V3: Between V2 and V4 on left side **V4: 5th intercostal space, left mid-clavicular line V5: Between V4 and V6 on the left side V6: 5th intercostal space, left mid-axillary line Gestational Age Test Dubowitz or Ballard Pre and Post-Ductal Blood Gas Studies - If right-to-left shunt occurs across the ductus arteriosus the PaO2 level obtained from a pre-ductal site (right arm) often exceeds the PaO2 level obtained from a post-ductal site (umbilical artery or a lower extremity vessel) - If the pre-ductal (right radial artery) PaO2 is 15 torr higher than the post-ductal (umbilical artery) PaO2, then the patient has a patent ductus arteriosus with a right to left shunt. PETCO2 (End tidal CO2) - An increase in end-tidal CO2 would indicate a decrease in ventilation - A decrease in end-tidal CO2 would indicate an increase in ventilation, or decreased perfusion. (deadspace disease; hypovolemia; pulmonary embolism) Manual Resuscitation Bag (self-inflating) - if bag becomes difficult to compress and patient compliance is normal, patient valve may be stuck open or closed. Cuff pressure 20 - 25 mmHg (25 - 35 cmH2O) Right mainstem intubation occurs when the oral ETT is inserted 25 cm Laryngeal Mask Airway (LMA) Inflate the cuff with just enough air to obtain the seal, corresponding to cuff pressure of 60 cmH2O. Frequently, only half this pressure is necessary to achieve an adequate seal. Trach tube cuff should be kept inflated whenever the patient is eating or on positive pressure ventilation When plugging the trach tube for a speaking trial... deflate the cuff, remove the inner cannula, and then plug the trach tube - if not tolerated, switch to fenestrated tube Cardiac Index CI = Qt / BSA Norm: 2.5 - 4 L/min