ECMO SPECIALIST EXAM| ECMO MANAGEMENT
FOR SPECIALISTS EXAM QUESTIONS WITH
VERIFIED SOLUTIONS NEWLY MODIFIED GRADED
A+ TESTED AND APPROVED!!!
what are the 5 factors affecting pharmacokinetics with critical illness? --
ANSWER--1. augmented cardiac output
2. leaky capillaries
3. volume resusitation
4. end-organ perfusion
5. altered protein binding
what is pharmacodynamics? --ANSWER--the bodys biological response to the
drug
what are the factors 5 affecting pharmacokinetics with ECMO? --ANSWER--1.
augmented cardiac output
2. leaky capillaries
3. end-organ perfusion
4. hemodilution
5. drug sequestration
Page 1 of 81
,which drugs should you avoid with ecmo? --ANSWER--benzos!!! lipophillic
and sequester in the tubing
why do we need anticoagulation on ecmo? --ANSWER--blood contacts the
ecmo circuit causing a sirs response and leads to:
inflammation/vasodilation
coagulation
altered fibrinolysis
how does heparin work? --ANSWER--Activates antithrombin III -> inactivates
thrombin, factor IXa, & factor Xa.
what are the 3 definitions of ards and how are they defined? --ANSWER--1.
Mild- pf ratio is 200-300 mmhg w/peep or CPAP > 5
2. moderate - pf ratio is 100 - 200 mmhg w/ peep or CPAP > 5
3. severe- pf ratio is <100 mmhg with peep > 5
what are the 3 consequences of lung injury with ards? --ANSWER--1. impaired
gas exchange
2. decreased compliance
3. increased pulmonary arterial pressure
Page 2 of 81
,what are the two things that happen with impaired gas exchange? --ANSWER--
1. V/Q mismatch - alveolar shunting
2. increased dead space - high minute ventilation and impaired CO2 elimination
what is the hallmark sign of ards? --ANSWER--decreased lung compliance --
due to stiff and poorly or non-aerated lungs
what are the three stages of ards? --ANSWER--1) Exudative- (4-7 days) --
interstitial edema, hyaline membranes, cytokine production, loss of coagulation
2) Proliferative (7-21 days ) -- alveolar and intimal fibrosis and proliferation of
type 2 cells and fibroblasts
3) Fibrotic ( >21 days) - extensive pulmonary fibrosis, loss of normal alveolar
architecture, emphasematous lungs
EPF= Each Pulmonary "F"ase
5 Causes of ards- pulmonary --ANSWER--1. pneumonia
2. aspiration
3. pulmonary contusion
4. inhalation injury
5. fat emboli
5 causes of ards- extra pulmonary --ANSWER--1. sepsis
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, 2. trauma
3. drug overdose
4. acute pancreatitis
5. cardiopulmonary bypass
3 ways to manage ards- evidence based --ANSWER--1. low tidal volume
ventilation - 6 ml/kg of ideal body weight
2. conservative fluid management - CVP < 4
3. neuromuscular blockades
How to recognize cardiogenic shock? (acronym) --ANSWER--CS-MODE
Cardiac Rhythm
SBP <90
Markers- cardiac
Output- oliguria
Drips - Inotropes/ pressers
Exam - cool, clammy, resp distress
How to diagnose shock ( acronym) --ANSWER--(ECLS )
ECG
Consult- surgeon
Page 4 of 81
FOR SPECIALISTS EXAM QUESTIONS WITH
VERIFIED SOLUTIONS NEWLY MODIFIED GRADED
A+ TESTED AND APPROVED!!!
what are the 5 factors affecting pharmacokinetics with critical illness? --
ANSWER--1. augmented cardiac output
2. leaky capillaries
3. volume resusitation
4. end-organ perfusion
5. altered protein binding
what is pharmacodynamics? --ANSWER--the bodys biological response to the
drug
what are the factors 5 affecting pharmacokinetics with ECMO? --ANSWER--1.
augmented cardiac output
2. leaky capillaries
3. end-organ perfusion
4. hemodilution
5. drug sequestration
Page 1 of 81
,which drugs should you avoid with ecmo? --ANSWER--benzos!!! lipophillic
and sequester in the tubing
why do we need anticoagulation on ecmo? --ANSWER--blood contacts the
ecmo circuit causing a sirs response and leads to:
inflammation/vasodilation
coagulation
altered fibrinolysis
how does heparin work? --ANSWER--Activates antithrombin III -> inactivates
thrombin, factor IXa, & factor Xa.
what are the 3 definitions of ards and how are they defined? --ANSWER--1.
Mild- pf ratio is 200-300 mmhg w/peep or CPAP > 5
2. moderate - pf ratio is 100 - 200 mmhg w/ peep or CPAP > 5
3. severe- pf ratio is <100 mmhg with peep > 5
what are the 3 consequences of lung injury with ards? --ANSWER--1. impaired
gas exchange
2. decreased compliance
3. increased pulmonary arterial pressure
Page 2 of 81
,what are the two things that happen with impaired gas exchange? --ANSWER--
1. V/Q mismatch - alveolar shunting
2. increased dead space - high minute ventilation and impaired CO2 elimination
what is the hallmark sign of ards? --ANSWER--decreased lung compliance --
due to stiff and poorly or non-aerated lungs
what are the three stages of ards? --ANSWER--1) Exudative- (4-7 days) --
interstitial edema, hyaline membranes, cytokine production, loss of coagulation
2) Proliferative (7-21 days ) -- alveolar and intimal fibrosis and proliferation of
type 2 cells and fibroblasts
3) Fibrotic ( >21 days) - extensive pulmonary fibrosis, loss of normal alveolar
architecture, emphasematous lungs
EPF= Each Pulmonary "F"ase
5 Causes of ards- pulmonary --ANSWER--1. pneumonia
2. aspiration
3. pulmonary contusion
4. inhalation injury
5. fat emboli
5 causes of ards- extra pulmonary --ANSWER--1. sepsis
Page 3 of 81
, 2. trauma
3. drug overdose
4. acute pancreatitis
5. cardiopulmonary bypass
3 ways to manage ards- evidence based --ANSWER--1. low tidal volume
ventilation - 6 ml/kg of ideal body weight
2. conservative fluid management - CVP < 4
3. neuromuscular blockades
How to recognize cardiogenic shock? (acronym) --ANSWER--CS-MODE
Cardiac Rhythm
SBP <90
Markers- cardiac
Output- oliguria
Drips - Inotropes/ pressers
Exam - cool, clammy, resp distress
How to diagnose shock ( acronym) --ANSWER--(ECLS )
ECG
Consult- surgeon
Page 4 of 81
