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Norepinephrine (Levophed) correct answers A1 > B1 This is the 1st line for sepsis!!!
Epinephrine correct answers A1 = B1 This is second line for sepsis!! Anaphylaxis is 1st line
Dopamine correct answers B1 > B2 Septic or Cardiogenic Shock (avoid in tachy states)
Phenylephrine (Neo) correct answers A1 - This has the least arrhythmia side effects so would
recommend using in a situation with tachyarrythmias (SVT)
Shock (3 different types...4 truly) correct answers 1. Hypovolemic - hemorrhage or dehydration
2. Cardiogenic - decreased cardiac output from ACS or heart failure
3. Obstructive - a subset of cardiogenic shock secondary to mechanical blockage in the central
circulation such as tension pneumo or embolism
4. Distributive - loss of vascular tone from anaphylaxis or sepsis
Fluid resuscitation in shock correct answers 30 ml/kg initial measurement
there has been recent evidence that fluid resuscitation with chloride rich fluids increases the risk
of kidney injury so may want to switch to lactated ringers
How to measure adequate resuscitation correct answers CVP goal of 8-12
Urine output 0.5 ml/kg/hour
Central venous oxygen saturation > 70% has been recommended as a target for resuscitation
Reduce lactate levels to 10-20% over the first 6 hours
smoke inhalation and stridor correct answers Need to perform endotracheal intubation as there is
evidence of swelling of the upper airway
Sub centimeter pulmonary nodule correct answers Defined as a lesion < 8 mm
Risk is then divided into high and low based on patient's age (50 or older increased risk), hx of
smoking, asbestos and randon exposure, COPD, radiation therapy, and family hx of lung cancer
If it is < 4mm, with low pre test probability, then no follow up needed
If there is previous imaging available, always review that first!!!
Pulmonary nodules 8 mm - 30 mm correct answers If pretest prob low - CT at 3, 6, 9, 12, 18 and
24 months
If intermediate of greater, need tissue diagnosis
When is spirometry indicated correct answers When COPD pt experiences a change in
symptoms
When is long term O2 needed in patient's with COPD correct answers 1. severe hypoxemia
defined as arterial PO2 less than or equal to 55 mmHg or an O2 sat < 88% on room air
, 2. If there is evidence of Pulm HTN, peripheral edema suggesting right sided heart failure or
polycythemia vera in combination with arterial PO2 less than 60 mmHg or oxygen saturation <
88% room air
COPD diagnosis correct answers Should be performed in any pt with chronic cough, dyspnea or
sputum production
Post and pre bronchodilator
A post bronchodilator reading of FEV1/FVC less than 70% is diagnostic of COPD
FEV1 is then used to assess the severity of the COPD
FEV1 - 50-80% moderate
FEV1 - 34 - 50 severe
FEV1 - < 34% is very severe
Increased lung volumes higher than predicted may point to hyperinflation and high residual
volume suggests air trapping. Lower than predicted DLCO suggests an effect on the lung
parenchyma = ephysema
How do you calculate the title volume correct answers 6-8ml/kg using predicted body weight
< 6 ml for most patients with ARDS
predicted body weight
Male: 50 + (0.91) [height (cm) - 152.4] or 50 + 2.3[height (inches) - 60]
Female: 45.5 + (0.91) [height (cm) - 152.4] or 45.5 + 2.3[height (inches) - 60]
What should be the minute ventilation correct answers Minute ventilation equals tital volume
times the respiration rate
A normal ventilation rate is 6-8 L/min
May need to be higher in metabolic states or when dead space was increased or when lung
protective strategies need to be used
How much oxygen is needed to start on ventilator correct answers Start with FIO2 of 1.0 and
quickly decrease as able
Goal at 92% - 95% for most patients
Start peep at 5 and increase to decrease high FIO2
Respiration rate to tidal volume ratio correct answers Ratio of less 105 has approximately 80%
chance of weaning
Ratio greater than 105 gaurentree resp failure
CPAP correct answers Continuous positive airway pressure
Uses continuous pressures pressure during inhalation and exhalation with the primary goal of
providing pressure on exhalation
BiPAP correct answers allows for increased pressure during inspiration with PEEP and will
potentially allow for higher tidal volume and CO2 clearing as well as decreased work of
breathing
Norepinephrine (Levophed) correct answers A1 > B1 This is the 1st line for sepsis!!!
Epinephrine correct answers A1 = B1 This is second line for sepsis!! Anaphylaxis is 1st line
Dopamine correct answers B1 > B2 Septic or Cardiogenic Shock (avoid in tachy states)
Phenylephrine (Neo) correct answers A1 - This has the least arrhythmia side effects so would
recommend using in a situation with tachyarrythmias (SVT)
Shock (3 different types...4 truly) correct answers 1. Hypovolemic - hemorrhage or dehydration
2. Cardiogenic - decreased cardiac output from ACS or heart failure
3. Obstructive - a subset of cardiogenic shock secondary to mechanical blockage in the central
circulation such as tension pneumo or embolism
4. Distributive - loss of vascular tone from anaphylaxis or sepsis
Fluid resuscitation in shock correct answers 30 ml/kg initial measurement
there has been recent evidence that fluid resuscitation with chloride rich fluids increases the risk
of kidney injury so may want to switch to lactated ringers
How to measure adequate resuscitation correct answers CVP goal of 8-12
Urine output 0.5 ml/kg/hour
Central venous oxygen saturation > 70% has been recommended as a target for resuscitation
Reduce lactate levels to 10-20% over the first 6 hours
smoke inhalation and stridor correct answers Need to perform endotracheal intubation as there is
evidence of swelling of the upper airway
Sub centimeter pulmonary nodule correct answers Defined as a lesion < 8 mm
Risk is then divided into high and low based on patient's age (50 or older increased risk), hx of
smoking, asbestos and randon exposure, COPD, radiation therapy, and family hx of lung cancer
If it is < 4mm, with low pre test probability, then no follow up needed
If there is previous imaging available, always review that first!!!
Pulmonary nodules 8 mm - 30 mm correct answers If pretest prob low - CT at 3, 6, 9, 12, 18 and
24 months
If intermediate of greater, need tissue diagnosis
When is spirometry indicated correct answers When COPD pt experiences a change in
symptoms
When is long term O2 needed in patient's with COPD correct answers 1. severe hypoxemia
defined as arterial PO2 less than or equal to 55 mmHg or an O2 sat < 88% on room air
, 2. If there is evidence of Pulm HTN, peripheral edema suggesting right sided heart failure or
polycythemia vera in combination with arterial PO2 less than 60 mmHg or oxygen saturation <
88% room air
COPD diagnosis correct answers Should be performed in any pt with chronic cough, dyspnea or
sputum production
Post and pre bronchodilator
A post bronchodilator reading of FEV1/FVC less than 70% is diagnostic of COPD
FEV1 is then used to assess the severity of the COPD
FEV1 - 50-80% moderate
FEV1 - 34 - 50 severe
FEV1 - < 34% is very severe
Increased lung volumes higher than predicted may point to hyperinflation and high residual
volume suggests air trapping. Lower than predicted DLCO suggests an effect on the lung
parenchyma = ephysema
How do you calculate the title volume correct answers 6-8ml/kg using predicted body weight
< 6 ml for most patients with ARDS
predicted body weight
Male: 50 + (0.91) [height (cm) - 152.4] or 50 + 2.3[height (inches) - 60]
Female: 45.5 + (0.91) [height (cm) - 152.4] or 45.5 + 2.3[height (inches) - 60]
What should be the minute ventilation correct answers Minute ventilation equals tital volume
times the respiration rate
A normal ventilation rate is 6-8 L/min
May need to be higher in metabolic states or when dead space was increased or when lung
protective strategies need to be used
How much oxygen is needed to start on ventilator correct answers Start with FIO2 of 1.0 and
quickly decrease as able
Goal at 92% - 95% for most patients
Start peep at 5 and increase to decrease high FIO2
Respiration rate to tidal volume ratio correct answers Ratio of less 105 has approximately 80%
chance of weaning
Ratio greater than 105 gaurentree resp failure
CPAP correct answers Continuous positive airway pressure
Uses continuous pressures pressure during inhalation and exhalation with the primary goal of
providing pressure on exhalation
BiPAP correct answers allows for increased pressure during inspiration with PEEP and will
potentially allow for higher tidal volume and CO2 clearing as well as decreased work of
breathing
