FCCS FUNDAMENTALS OF CRITICAL
CARE SUPPORT EXAM STUDY GUIDE
Questions and Verified Answers| 100% Correct
GRADED A+ Guaranteed PASS Latest version
2025
QUESTION
Guidelines for the Initiation of Mechanical Ventilation
Answer:
- Choose the ven- tilator mode with which you are most familiar. The primary goals of
ventilatory support are adequate oxygenation/ventilation, reduced work of breathing, synchrony
between patient and ventilator, and avoidance of high end-inspiration alveolar pres- sures.
- The initial FIO2 should be *1.0.* The FIO2 thereafter can be titrated downward to maintain the
SpO2 at 92% to 94%. In severe acute respiratory distress syndrome, SpO2 e88% may be
acceptable to minimize complications of mechanical ventilation.
- Initial VT = *8 to 10 mL/kg* in patients with relatively *normal lung compliance*.
In patients with poor lung compliance (eg, ARDS), a target VT of 6 mL/kg by PBW is
recommended to avoid overdistension and maintain an inspiratory plateau pressure d30 cm H2O.
- Choose a respiratory rate and minute ventilation appropriate for the particular clinical
requirements. Target pH, not PaCO2.
- Use PEEP in diffuse lung injury to maintain an open alveoli at end expiration. If volume is held
constant, PEEP may increase peak inspiratory plateau pressure, a potentially undesirable effect in
ARDS. PEEP levels >15 cm H2O are rarely necessary.
- Set the trigger sensitivity to allow minimal patient effort to initiate inspiration. Beware of auto
cycling if the trigger setting is too sensitive.
- In patients at risk of obstructive airway disease, avoid choosing ventilator settings that limit
expiratory time and cause or worsen auto-PEEP.
- Call the critical care consultant or other appropriate consultant for assistance.
QUESTION
What respiratory conditions are likely to respond to Noninvasive Positive
Pressure Ventilation?
Answer:
, Hypoxemic Respiratory Failure:
- Cardiogenic pulmonary edema without hemodynamic instability
- Respiratory failure in patients with mild to moderate Pneumocystis pneumonia
- Respiratory failure in immunocompromised patients (especially in hematologic malignancies
and transplant patients)
Hypercapnic Respiratory Failure:
- Acute exacerbation of chronic obstructive pulmonary disease
- Acute exacerbation of asthma
- Respiratory failure in patients with cystic fibrosis
QUESTION
Use the following initial ventilator settings for BiPAP
Answer:
Mode: Spontaneous
Trigger: Maximum sensitivity
FIO2: 1.00
EPAP: 4-5 cm H2O (higher levels are poorly tolerated initially) IPAP: 10-15 cm H2O
Backup rate: Start at 6/min
QUESTION
IPAP > 20 cm H2O may lead to
Answer:
gastric distension
QUESTION
Contraindications to Use of Noninvasive Positive Pressure Ventilation
Answer:
- Cardiac or respiratory arrest
- Hemodynamic instability
- Myocardial ischemia or arrhythmias
- Patient who is unable to cooperate
- Inability to protect the airway
- High risk for aspiration
,- Active upper gastrointestinal hemorrhage
- Severe hypoxemia
- Severe encephalopathy
- Facial trauma, recent surgery, and/or burns
- Significant agitation
QUESTION
Measurements of global oxygen balance that may be useful in monitoring the seriously ill patient
include and
Answer:
central venous oxyhemoglobin saturation (*ScvO2*) and
*lactate* concentrations.
QUESTION
How do you measure ScvO2?
Answer:
ScvO2 can be obtained continuously or inter- mittently from a catheter placed in the internal
jugular or subclavian vein
ScvO2 correlates with the mixed venous oxyhemoglobin saturation (SVO2) obtained from a
pulmonary artery catheter in the pulmonary artery.
QUESTION
How do you measure SvO2?
Answer:
PA catheter in pulmonary artery
- this is a mixed venous sample
The SVO2 measures the oxyhemoglobin saturation of blood from the superior vena
cava and the inferior vena cava that has been mixed in the right ventricle. These measures of
venous oxyhemoglobin saturation represent the amount of oxygen still bound to hemoglobin
after traversing the tissue capillaries and returning to the right heart; the decrease from the SaO2
estimates the amount of oxygen utilized
, QUESTION
In normal individuals, the SVO2 is % and the ScvO2 is 2% to 3%
lower.
However, in patients with shock and/or hypoperfusion, the ScvO2 may be 5% to 7% higher than
the SVO2 due to greater desaturation of venous blood from the gastrointestinal tract contributing
to SVO2
Answer:
>65%
QUESTION
Low values of ScvO2 suggest an imbalance in the oxygen supply and demand. This imbalance
may be due to decreases in :
-
-
-
Patients may have more than one abnormality contributing to oxygen imbal- ance.
Answer:
- cardiac output
- hemoglobin concentration, or SaO2,
- increases in tissue oxygen consumption.(fever/sepsis)
QUESTION
A normal ScvO2 may still be associated with tissue hypoxia in conditions such as severe sepsis
and certain poisonings (eg, ). Further evalua- tions of lactate concentration and organ
function are needed to assess oxygen balance in the seriously ill patient when the ScvO2 is
normal.
Answer:
cyanide
QUESTION
Lactate is another indicator of the overall oxygen balance. It is produced during anaerobic
metabolism when cellular occurs. The eleva- tion of blood lactate in shock and
CARE SUPPORT EXAM STUDY GUIDE
Questions and Verified Answers| 100% Correct
GRADED A+ Guaranteed PASS Latest version
2025
QUESTION
Guidelines for the Initiation of Mechanical Ventilation
Answer:
- Choose the ven- tilator mode with which you are most familiar. The primary goals of
ventilatory support are adequate oxygenation/ventilation, reduced work of breathing, synchrony
between patient and ventilator, and avoidance of high end-inspiration alveolar pres- sures.
- The initial FIO2 should be *1.0.* The FIO2 thereafter can be titrated downward to maintain the
SpO2 at 92% to 94%. In severe acute respiratory distress syndrome, SpO2 e88% may be
acceptable to minimize complications of mechanical ventilation.
- Initial VT = *8 to 10 mL/kg* in patients with relatively *normal lung compliance*.
In patients with poor lung compliance (eg, ARDS), a target VT of 6 mL/kg by PBW is
recommended to avoid overdistension and maintain an inspiratory plateau pressure d30 cm H2O.
- Choose a respiratory rate and minute ventilation appropriate for the particular clinical
requirements. Target pH, not PaCO2.
- Use PEEP in diffuse lung injury to maintain an open alveoli at end expiration. If volume is held
constant, PEEP may increase peak inspiratory plateau pressure, a potentially undesirable effect in
ARDS. PEEP levels >15 cm H2O are rarely necessary.
- Set the trigger sensitivity to allow minimal patient effort to initiate inspiration. Beware of auto
cycling if the trigger setting is too sensitive.
- In patients at risk of obstructive airway disease, avoid choosing ventilator settings that limit
expiratory time and cause or worsen auto-PEEP.
- Call the critical care consultant or other appropriate consultant for assistance.
QUESTION
What respiratory conditions are likely to respond to Noninvasive Positive
Pressure Ventilation?
Answer:
, Hypoxemic Respiratory Failure:
- Cardiogenic pulmonary edema without hemodynamic instability
- Respiratory failure in patients with mild to moderate Pneumocystis pneumonia
- Respiratory failure in immunocompromised patients (especially in hematologic malignancies
and transplant patients)
Hypercapnic Respiratory Failure:
- Acute exacerbation of chronic obstructive pulmonary disease
- Acute exacerbation of asthma
- Respiratory failure in patients with cystic fibrosis
QUESTION
Use the following initial ventilator settings for BiPAP
Answer:
Mode: Spontaneous
Trigger: Maximum sensitivity
FIO2: 1.00
EPAP: 4-5 cm H2O (higher levels are poorly tolerated initially) IPAP: 10-15 cm H2O
Backup rate: Start at 6/min
QUESTION
IPAP > 20 cm H2O may lead to
Answer:
gastric distension
QUESTION
Contraindications to Use of Noninvasive Positive Pressure Ventilation
Answer:
- Cardiac or respiratory arrest
- Hemodynamic instability
- Myocardial ischemia or arrhythmias
- Patient who is unable to cooperate
- Inability to protect the airway
- High risk for aspiration
,- Active upper gastrointestinal hemorrhage
- Severe hypoxemia
- Severe encephalopathy
- Facial trauma, recent surgery, and/or burns
- Significant agitation
QUESTION
Measurements of global oxygen balance that may be useful in monitoring the seriously ill patient
include and
Answer:
central venous oxyhemoglobin saturation (*ScvO2*) and
*lactate* concentrations.
QUESTION
How do you measure ScvO2?
Answer:
ScvO2 can be obtained continuously or inter- mittently from a catheter placed in the internal
jugular or subclavian vein
ScvO2 correlates with the mixed venous oxyhemoglobin saturation (SVO2) obtained from a
pulmonary artery catheter in the pulmonary artery.
QUESTION
How do you measure SvO2?
Answer:
PA catheter in pulmonary artery
- this is a mixed venous sample
The SVO2 measures the oxyhemoglobin saturation of blood from the superior vena
cava and the inferior vena cava that has been mixed in the right ventricle. These measures of
venous oxyhemoglobin saturation represent the amount of oxygen still bound to hemoglobin
after traversing the tissue capillaries and returning to the right heart; the decrease from the SaO2
estimates the amount of oxygen utilized
, QUESTION
In normal individuals, the SVO2 is % and the ScvO2 is 2% to 3%
lower.
However, in patients with shock and/or hypoperfusion, the ScvO2 may be 5% to 7% higher than
the SVO2 due to greater desaturation of venous blood from the gastrointestinal tract contributing
to SVO2
Answer:
>65%
QUESTION
Low values of ScvO2 suggest an imbalance in the oxygen supply and demand. This imbalance
may be due to decreases in :
-
-
-
Patients may have more than one abnormality contributing to oxygen imbal- ance.
Answer:
- cardiac output
- hemoglobin concentration, or SaO2,
- increases in tissue oxygen consumption.(fever/sepsis)
QUESTION
A normal ScvO2 may still be associated with tissue hypoxia in conditions such as severe sepsis
and certain poisonings (eg, ). Further evalua- tions of lactate concentration and organ
function are needed to assess oxygen balance in the seriously ill patient when the ScvO2 is
normal.
Answer:
cyanide
QUESTION
Lactate is another indicator of the overall oxygen balance. It is produced during anaerobic
metabolism when cellular occurs. The eleva- tion of blood lactate in shock and
