Respiratory and Critical Care Decision-Making
Guide: High-Yield Q&A
In difficult intubation, when traditional intubation with laryngoscope has failed and patient is starting to
have low saturations, why is video laryngoscopy preferred over fiberoptic bronchoscopy to intubate? -
✔✔Fiberoptic bronchoscopy is an alternative method, but is technically difficult and requires specialized
equipment
Patient is on a ventilator with a chest tube in place. What is the cause of the low minute alarm and
increased peak pressures (leak)? And what is your action to look for? - ✔✔This is a bronchopleural
fistula, air leak causing low minute ventilation alarm. Action is to look at water seal chamber.
Succinocholine is contraindicated in what type of patients, what pathology? - ✔✔Burn patients (high
potassium, need fluids)
How can high flow nasal cannula help with a patient having pulmonary contusion (bruised lungs) from
MVA, and atelectasis on x ray with desaturation? - ✔✔HFNC can improve atelectasis by providing CPAP
(PEEP) to recruit alveoli while lungs heal, and this will increase saturation as well.
Brain dead patients, have an increase of sugar in their blood leading to what condition? - ✔✔Polyuria,
increased urination leading to the body trying to excrete sugar
Normal Troponin level, even though troponin is at .2, what does this NOT suggest? - ✔✔0.0 - 0.10
ng/mL, (less than .001 mg/ml) myocardial infaction.
Since transudate suggest an effusion from a non malignant not infected source, what is not indicated?
When is a chest tube insertion recommended for transudate? - ✔✔Invasive more aggressive options.
Can just monitor patient.
If pleural effusion reaccumulates
, If a recruitment maneuver works in patient, even in prone positioning or supine, what is your next step
to maintain this increased saturation of patient? - ✔✔Increase PEEP level
Vital capacity normal value is 10 mg/ml, a value of 7 indicates what? - ✔✔Weakness! Place on
ventilator! Intubate!
What is normal ICP range in mmhg? What is a trigger for decorticate posturing in patient and what can
help? - ✔✔5-15 mmhg, Fentanyl is good for relieving painful stimulus causing muscles to contract
without hemodynamic effects
Pentobarbital coma is only indicated for what condition that is refractory? - ✔✔Refractory high ICP (5-
15), so ICP greater than 15 would be an indication
Difficult intubation, do NOT choose what? - ✔✔FIBEROPTIC BRONCHOSCOPY!!!!!!! ONLY VIDEO
ASSISTED!
Nitroprusside will decrease all values except what?
Pa02/Fi02, Cardiac preload, pulmonary arterial pressure, ventilation perfusion mixmatch? -
✔✔Nitroprusside will decrease all, but ONLY increase V/Q mixmatch
Humidification on a ventilator with PASSIVE humidification means ventilator is humidified by what? How
do you deliver an aerosol with PASSIVE vs ACTIVE humidity? - ✔✔HME
PASSIVE: bypass HME
ACTIVE: Vibrating mesh
What are the three best ways to limit ventilator induced lung injury? - ✔✔Reduce o2 toxicity, reduce
alveolar stretch, and reducing atelectrauma, NO normalizing.
What is the best way to determine pleural effusion in a patient, CT scan or thoracic ultrasound? -
✔✔Thoracic ultrasound can be done at bedside, CT requires transport (always a risk in transport)
Guide: High-Yield Q&A
In difficult intubation, when traditional intubation with laryngoscope has failed and patient is starting to
have low saturations, why is video laryngoscopy preferred over fiberoptic bronchoscopy to intubate? -
✔✔Fiberoptic bronchoscopy is an alternative method, but is technically difficult and requires specialized
equipment
Patient is on a ventilator with a chest tube in place. What is the cause of the low minute alarm and
increased peak pressures (leak)? And what is your action to look for? - ✔✔This is a bronchopleural
fistula, air leak causing low minute ventilation alarm. Action is to look at water seal chamber.
Succinocholine is contraindicated in what type of patients, what pathology? - ✔✔Burn patients (high
potassium, need fluids)
How can high flow nasal cannula help with a patient having pulmonary contusion (bruised lungs) from
MVA, and atelectasis on x ray with desaturation? - ✔✔HFNC can improve atelectasis by providing CPAP
(PEEP) to recruit alveoli while lungs heal, and this will increase saturation as well.
Brain dead patients, have an increase of sugar in their blood leading to what condition? - ✔✔Polyuria,
increased urination leading to the body trying to excrete sugar
Normal Troponin level, even though troponin is at .2, what does this NOT suggest? - ✔✔0.0 - 0.10
ng/mL, (less than .001 mg/ml) myocardial infaction.
Since transudate suggest an effusion from a non malignant not infected source, what is not indicated?
When is a chest tube insertion recommended for transudate? - ✔✔Invasive more aggressive options.
Can just monitor patient.
If pleural effusion reaccumulates
, If a recruitment maneuver works in patient, even in prone positioning or supine, what is your next step
to maintain this increased saturation of patient? - ✔✔Increase PEEP level
Vital capacity normal value is 10 mg/ml, a value of 7 indicates what? - ✔✔Weakness! Place on
ventilator! Intubate!
What is normal ICP range in mmhg? What is a trigger for decorticate posturing in patient and what can
help? - ✔✔5-15 mmhg, Fentanyl is good for relieving painful stimulus causing muscles to contract
without hemodynamic effects
Pentobarbital coma is only indicated for what condition that is refractory? - ✔✔Refractory high ICP (5-
15), so ICP greater than 15 would be an indication
Difficult intubation, do NOT choose what? - ✔✔FIBEROPTIC BRONCHOSCOPY!!!!!!! ONLY VIDEO
ASSISTED!
Nitroprusside will decrease all values except what?
Pa02/Fi02, Cardiac preload, pulmonary arterial pressure, ventilation perfusion mixmatch? -
✔✔Nitroprusside will decrease all, but ONLY increase V/Q mixmatch
Humidification on a ventilator with PASSIVE humidification means ventilator is humidified by what? How
do you deliver an aerosol with PASSIVE vs ACTIVE humidity? - ✔✔HME
PASSIVE: bypass HME
ACTIVE: Vibrating mesh
What are the three best ways to limit ventilator induced lung injury? - ✔✔Reduce o2 toxicity, reduce
alveolar stretch, and reducing atelectrauma, NO normalizing.
What is the best way to determine pleural effusion in a patient, CT scan or thoracic ultrasound? -
✔✔Thoracic ultrasound can be done at bedside, CT requires transport (always a risk in transport)
