Respiratory Emergencies and Mechanical Ventilation Flashcards

A patient's end-tidal CO2 (ETCO2) drops suddenly to near zero after intubation. What is the most likely cause?

Answer: Esophageal intubation

A sudden drop of ETCO2 to near zero after intubation is the hallmark of esophageal intubation, as the esophagus does not produce CO2 in exhaled gas.

What is the maximum recommended cuff pressure for an endotracheal tube to prevent tracheal mucosal ischemia?

Answer: 20–30 cmH2O

ETT cuff pressure should be maintained at 20–30 cmH2O (15–22 mmHg) to seal the airway without compromising tracheal mucosal perfusion.

Which finding is most consistent with a right mainstem bronchus intubation?

Answer: Absent left-sided breath sounds, high peak pressures, and SpO2 decline

Right mainstem intubation results in the left lung being bypassed, producing absent left-sided breath sounds, elevated peak pressures, and hypoxia.

A transport patient with COPD has a PaCO2 of 78 mmHg and pH of 7.22. What ventilator adjustment addresses the respiratory acidosis?

Answer: Increase respiratory rate or tidal volume to increase minute ventilation

Increasing minute ventilation (via rate or tidal volume) enhances CO2 elimination, raising pH and correcting respiratory acidosis.

Which intervention is indicated for a massive hemothorax identified during air transport?

Answer: Chest tube insertion at the fourth or fifth ICS, anterior axillary line

Massive hemothorax is managed with a large-bore chest tube inserted at the fourth or fifth ICS, anterior axillary line to drain blood and re-expand the lung.

What does an increasing plateau pressure with unchanged peak pressure suggest in a ventilated patient during transport?

Answer: Decreased lung or chest wall compliance

Plateau pressure reflects lung and chest wall compliance; a rising plateau with stable peak pressure suggests decreased pulmonary compliance (e.g., worsening ARDS, pneumothorax, or fluid overload).