RRT Ultimate Flashcards

A patient with myasthenia gravis is in respiratory failure. Which measurement BEST indicates the need for intubation?

Answer: Vital capacity < 15 mL/kg

The 20-30-40 rule in neuromuscular disease: VC < 20 mL/kg, MIP weaker than -30 cmH2O, or MEP < 40 cmH2O indicate impending failure.

Which FEV1/FVC ratio is most consistent with obstructive lung disease?

Answer: 0.65

An FEV1/FVC ratio below 0.70 (or the LLN) is the diagnostic criterion for airflow obstruction per GOLD guidelines.

Which inhaled medication is classified as a long-acting muscarinic antagonist (LAMA) used in COPD management?

Answer: Tiotropium

Tiotropium is a once-daily LAMA that blocks M3 muscarinic receptors, reducing bronchoconstriction in COPD.

What is the MOST common complication of endotracheal suctioning?

Answer: Hypoxemia

Suctioning removes oxygen along with secretions, making hypoxemia the most frequent complication, especially if pre-oxygenation is omitted.

A patient receiving heated high-flow nasal cannula (HFNC) at 40 L/min and FiO2 0.60 still has SpO2 of 86%. What is the BEST next step?

Answer: Transition to non-invasive positive pressure ventilation (NIV) or intubation

Failure to maintain adequate oxygenation on maximal HFNC settings is an indication to escalate to NIV or invasive mechanical ventilation.

Which acid-base disorder is associated with prolonged nasogastric suctioning?

Answer: Metabolic alkalosis

Loss of gastric HCl via NG suction removes acid, leaving a net alkalotic state—metabolic alkalosis.

During a helium-oxygen (heliox) therapy session, the therapist notices significant improvement in a patient's stridor. What does this indicate?

Answer: The obstruction is in the upper airway (large airway)

Heliox reduces turbulent flow in large, obstructed upper airways; its benefit implies the obstruction is in a region where flow is turbulent.