General critical care -ACCS exam (2022/2023) rated A+

General critical care -ACCS exam (2022/2023) rated A+ What is the thyromental distance? ✔✔Measurement of the distance between the upper edge of the thyroid cartilage to the chin, while the neck is completely extended. ...

General critical care -ACCS exam (2022/2023) rated A+ What is the thyromental distance? ✔✔Measurement of the distance between the upper edge of the thyroid cartilage to the chin, while the neck is completely extended. Thyromental distance: what indicates a suspected difficult intubation? ✔✔Less than 6 cm Thyromental distance: what suggests a non-problematic intubation? ✔✔7 cm or greater What type of x-ray should you use to determine proper position of an endotracheal tube? ✔✔AP x-ray What type of x-ray is helpful in detecting pleural effusions? ✔✔Lateral decubitus The description "concave superior border or interface" describes what? ✔✔A pleural effusion What type of x-ray is helpful and spotting internal issues such as masses, blebs, or lesions? ✔✔Oblique x-ray On x-ray, where should the end of the endotracheal tube be positioned? ✔✔2-5 cm above the carina On x-ray, where should the central venous catheter be positioned? ✔✔The tip should rest in the right atrium or vena cava On x-ray, where should the pulmonary artery catheter be positioned? ✔✔The tip should be over the right lower lung field What type of diagnostic imaging is used to detect the functionality of organs? ✔✔PET scan What is the gas the patient breathes during a V/Q scan? ✔✔Xenon On V/Q scan, what do dark areas of the lungs indicate? ✔✔Absence of ventilation in that area On V/Q scan, the description "wedge shaped" indicates what? ✔✔A clot What is considered normal work of breathing? ✔✔0.5-0.7 J/L Three key criteria for brain death ✔✔1. Unresponsiveness 2. Absence of reflexes 3. Presence of apnea Normal stroke volume ✔✔50-100 mL Normal ejection fraction ✔✔50-70% The best lead to determine the left ventricle status ✔✔V5 The best lead to determine overall electrical condition of the heart ✔✔Lead II Hypertrophy will cause an axis deviation in what direction? ✔✔In the direction of the hypertrophy, usually to the left, as in CHF If tissues are infarcted or dead, the axis will deviate where? ✔✔Away from the infarcted tissue Myocardial ischemia is what? ✔✔A current lack of oxygen to the cardiac muscle. Myocardial ischemia shows as what on an EKG? ✔✔Flipped T waves Myocardial injury is what? ✔✔Cardiac tissue currently dying How does Myocardial injury present on EKG? ✔✔Elevated ST segments Myocardial infarction is what? ✔✔Dead cardiac tissue, old or fresh How does myocardial infarction present on EKG? ✔✔Profound Q waves Normal CVP range ✔✔2-6 mmHg Normal PAP ✔✔25/8 mmHg or 14 Normal PCWP (pulmonary capillary wedge pressure) ✔✔4-12 mmHg or 8 mmHg Where is the best place to get a mixed venous sample? ✔✔PAP Normal cardiac output ✔✔4-8 L/min Normal MAP range ✔✔85-100 mmHg What is the most common complication of PA catheter insertion? ✔✔Cardiac arrhythmias Once the PA catheter is in the right atrium, what is the next? ✔✔The balloon is inflated and the catheter flows into the pulmonary artery where the balloon is deflated What is the dicrotic notch indicative of? ✔✔It represents the closure of the pulmonic valve If the dicrotic notch is not present, the situation is called what? ✔✔Pressure dampening What does pressure dampening indicate? ✔✔A possible obstruction to the PA catheter Four steps that should be taken to resolve pressure dampening ✔✔1. Check transducer dome for air bubbles 2. Aspirate - to remove a potential clot 3. Flush the catheter 4. Rotate the catheter It is very important to not _____ or _____ the catheter to address pressure dampening ✔✔Advance, Withdrawal Where specifically should you draw a mixed venous sample? ✔✔Distal lumen ____ Is the initial action for shock ✔✔Fluid administration A pH of what indicates respiratory failure? ✔✔<7.25 If a patient is given this drug and feels better, the patient is positive for myasthenia gravis ✔✔Tensilon (edrophonium) If a patient crashes after Tensilon administration, this is called what? ✔✔Anti-cholinergic crisis An anti-cholinergic crisis should be treated with what? ✔✔Atropine Once VC falls below 1.0 L, what should you do? ✔✔Intubate and mechanically ventilate If the cerebral spinal fluid comes back positive for protein, the patient is positive for what? ✔✔Guillain-Barre Syndrome How should you treat fulminating pulmonary edema? ✔✔-diuretic -100% oxygen -positive pressure ventilation -digitalis If PetCO2 is more than 10 mmHg less than PaCO2 what does this indicate? ✔✔Deadspace ventilation/pulmonary embolism What does an AHI score greater than 30 indicate? ✔✔Severe sleep apnea. The next step is to do a titration study How should central sleep apnea be treated? ✔✔-Respiratory stimulating medication such as Doxapram -Ventilatory assistance with a ventilator If a patient has recently been transfused with blood/blood products, and they develop acute bilateral crackles, wheezing, and a fever with in the first six hours following transfusion, what does this indicate? ✔✔TRALI/transfusion - related lung injury What does a GFR less than 15 mL/min indicate? ✔✔Kidney failure Normal creatinine ✔✔0.6-1.2 mg/dL Normal BUN ✔✔6-24 mg/dL Normal INR when patient is not on anticoagulant medication ✔✔0.8-1.3 Target INR when thin blood is desirable ✔✔2.0-3.0 Therapeutic INR when taking Coumadin ✔✔1.5-2.0 Normal PT ✔✔10-15 sec Normal platelet count ✔✔150,000-400,000 If the urine color looks dark light dark tea, what could this indicate? ✔✔Rhabdomylosis Normal hemoglobin ✔✔12-16 Normal RBCs ✔✔4-6 Normal hematocrit ✔✔45% Normal troponin ✔✔<0.2 ug/L Normal BNP ✔✔<300 Normal CK-MB ✔✔<10.5 Hypokalemia will cause what on EKG? ✔✔Flattened T waves Hyperkalemia will cause what on EKG? ✔✔Spiked T waves When the arterial blood appears chocolate brown in color, what is this indicative of? ✔✔Methemoglobinemia A chest tube must be clamped for how long to be discontinued? ✔✔24 hours VEST therapy should be set at what? ✔✔5-25 Hz IPV frequency should be set at what? ✔✔30 psi What type of items are allowed near the MRI machine? ✔✔Only non-ferrous items Sepsis acquired in hospitals is most commonly from what? ✔✔Urinary catheters and IVs During apnea testing, the patient's temp should be what? ✔✔Normothermic What indicates a positive apnea test? ✔✔-PaCO2 has risen by 60 torr -PaCO2 is at least 20 torr above baseline _____ is a medication often used with organ preservation because it helps to prevent hypotension ✔✔Desmopressin If the pressure from an arterial line is different from the blood pressure cuff, which one should you trust? ✔✔Trust the cuff pressure The vacuum pressure from the wall should be set high enough to achieve what? ✔✔Continuous bubbling in the suction control bottle If there is no bubbling in the water-seal chamber, what is happening? ✔✔Suction is not enough If a catheter site develops signs of infection, what should be done immediately? ✔✔remove the catheter The inability to pass a suction catheter beyond the distal tip of the ETT suggests what? ✔✔an obstruction If you are unable to pass a suction catheter beyond the distal tip of the ETT, what should you do? ✔✔deflate the cuff and try to pass the catheter again If a chest tube is accidentally removed (in transport for ex), what should be done immediately? ✔✔place petroleum jelly on the exit wound and dress with gauze and tape When a patient is on paralytic medications and on a ventilator, what alarm should you pay extra close attention to? ✔✔low peep A method of pulmonary hygiene that can be used when suctioning and other efforts are insufficient ✔✔mini-BAL Right atrium normal pressure ✔✔5/1 mmHg Right ventricle normal pressure ✔✔25/2 mmHg If the dicrotic notch is missing from the PA waveform and the pressure reading is 25/2, what needs to be done? ✔✔inflate the balloon and advance the catheter A pt who is being mechanically ventilated in PC mode, has peak pressure of 47 cmH2O and a plateau pressure of 30 cmH2O. In addition, the pt is becoming harder to ventilate and is not oxygenating adequately. What should be done to remedy this? ✔✔switch over to HFOV Shortening i-time will have what effect on systemic hemodynamics? ✔✔improve systemic hemodynamics A sulcus sign on x-ray is associated with what? ✔✔pneumothorax Pt's with kidney failure, in need of renal replacement therapy would benefit from what? ✔✔veno-venous hemofiltration 3 key strategies in the management of refractory hypoxemia ✔✔1. reduce risk for oxygen toxicity 2. minimize alveolar stretch 3. reduce atelectrauma If system flush pressure on an arterial line system is too high, what will happen? ✔✔pressure dampening The presence of serum protein in pleural fluid indicates what? ✔✔exudate a central strategy in preventing VAP ✔✔use of NIPPV, or early extubation to NIPPV If a patient has recently had a heart attack or is currently having a heart attack, what is MOST helpful in preserving cardiac tissue? ✔✔therapeutic hypothermia protocol