RRT Clinical Concepts Flashcards

A patient with ARDS has a PaO2 of 55 mmHg on FiO2 0.80. The best next step is to:

Answer: Apply PEEP of 10 cmH2O

Increasing PEEP recruits alveoli and improves oxygenation in ARDS more effectively than simply raising FiO2 beyond 0.80.

Which ventilator parameter best reflects small airway resistance in a mechanically ventilated patient?

Answer: Peak inspiratory pressure

Peak inspiratory pressure reflects both airway resistance and lung/chest wall compliance, making it the primary indicator of small airway resistance changes.

A patient receiving mechanical ventilation develops sudden hypotension, decreased breath sounds on the left, and tracheal deviation to the right. The priority action is:

Answer: Perform needle decompression of the left chest

These signs indicate tension pneumothorax, which requires immediate needle decompression before imaging.

Which bronchodilator class works by inhibiting acetylcholine receptors to reduce bronchoconstriction?

Answer: Anticholinergics

Anticholinergics such as ipratropium block muscarinic receptors, preventing acetylcholine-mediated bronchoconstriction.

A patient's arterial blood gas shows pH 7.25, PaCO2 60 mmHg, HCO3 25 mEq/L. This represents:

Answer: Acute respiratory acidosis

The low pH with elevated PaCO2 and near-normal bicarbonate indicates acute respiratory acidosis without metabolic compensation.

The primary goal of lung-protective ventilation in ARDS is to prevent:

Answer: Ventilator-induced lung injury

Lung-protective ventilation uses low tidal volumes (4-6 mL/kg IBW) and limited plateau pressures to prevent ventilator-induced lung injury (VILI).

During a spontaneous breathing trial, which finding would indicate the patient is NOT ready for extubation?

Answer: Rapid shallow breathing index (RSBI) of 120

An RSBI greater than 105 predicts failure of extubation; an RSBI of 120 indicates the patient is breathing too rapidly and shallowly.