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If a pt has a thyromental distance of 2 cm, what can you
expect about their airway? - Answer-Difficult airway w/ an
anteriorly displaced larynx
A COPD pt comes in with difficulty breathing. He then
becomes apneic and unresponsive. How would you
ventilate this pt? - Answer-BVM
A pt arrives after falling from a ladder and has a frontal
laceration. On examination, you find papilledema and
labored breathing w/o being able to clear secretions. What
is your biggest concern when intubating this pt? - Answer-
Cerebral edema/increasing ICP
Intubation tends to cause an increase in ICP. Administer
lidocaine prior to intubation to inhibit vagal stimulation.
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An ESRD pt w/ hyperkalemia develops dyspnea and
requires intubation. Which paralytic agent/NMB should you
avoid and why? - Answer-Succinylcholine
Worsens hyperkalemia
A pt is admitted after an OD. He starts to have apneic
episodes and his SpO2 is dropping. You place him on a
non-rebreather mask w/ 100% O2, yet his SpO2 remains
at 80%. Why is it not being corrected?
Then, if you try a BVM and it also fails, and video
laryngoscopy is unavailable, what is your next best choice
for an airway? - Answer-The pt is having apneic episodes,
which means that administering high-flow O2 will be
ineffective.
Choose an LMA if the BVM fails.
What is the most important sign in a critically ill pt? Why? -
Answer-Tachypnea
Indicates metabolic acidosis w/ respiratory alkalosis
compensation
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A pt misses dialysis for a few days and comes in with fluid
overload. He's tachycardic and tachypneic. On physical
exam, you find JVD, pulsus paradoxus (20 mmHg drop
during inspiration), and HoTN (80/40) with distant, muffled
heart sounds. Lungs are clear to auscultation. What is the
dx? - Answer-Cardiac tamponade; obstructive shock
What intervention improves outcomes with ROSC after
cardiac arrest? - Answer-Targeted temperature
management.
32-36 C
A shunt means there is perfusion without ventilation. What
disease process is an example of a shunt? - Answer-
Pneumonia
Which type of respiratory failure occurs with CNS
depression after an OD? - Answer-Acute hypercapnic
respiratory failure --> mixed
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A 50 y/o pt is having a COPD exacerbation. You have tried
steroids, bronchodilators, etc. with no improvement. PCO2
is in the 90s, pH is 7.20. You decide to intubate. Vent
settings are: VT 375, RR 20, FiO2 .35, PEEP 5. CXR is
normal. A few minutes later, his BP drops to 70/40. Lungs
are clear/equal. Vent shows peak airway pressure of 55
(high) and plateau pressure of 15. End expiratory hold
gives auto-peep of 15.
What is the cause of this pt's HoTN and why? - Answer-
Auto-peep is the cause.
COPD pts have difficulty exhaling --> pressure buildup in
alveoli.
We use PEEP for the pressure and to improve
oxygenation. Auto-peep comes from breath-stacking -->
intrinsic peep. Alveoli enlarge --> high peak airway
pressure. All leads to low venous return --> low CO -->
HoTN
A COPD pt is admitted to the ICU for exacerbation. Pt is
on a vent. Pt is tx w/ bronchodilators, steroids, and Abx.
ABG was normal 1 hr ago, but now the peak airway