RRT RRT Clinical Concepts 4

Question 1

A patient with Guillain-Barré syndrome has FVC declining toward 15 mL/kg. The appropriate action is:

Accepted Answer

Begin prophylactic intubation

Answer

The '20-30-40 rule' (FVC <20 mL/kg, MIP >-30 cmH2O, MEP <40 cmH2O) triggers prophylactic intubation before respiratory failure occurs.

Question 2

Which type of pulmonary edema is caused by increased hydrostatic pressure rather than increased permeability?

Accepted Answer

Cardiogenic pulmonary edema

Answer

Cardiogenic pulmonary edema results from elevated pulmonary capillary hydrostatic pressure due to left heart failure forcing fluid into alveoli.

Question 3

A mechanically ventilated patient's plateau pressure rises from 22 to 35 cmH2O with no change in peak pressure. This suggests:

Accepted Answer

Decreased lung compliance

Answer

A rise in plateau pressure without a change in the peak-to-plateau difference indicates a compliance problem, not a resistance problem.

Question 4

Which arterial blood gas pattern is expected during the initial compensatory response to metabolic acidosis?

Accepted Answer

Decreased PaCO2

Answer

The respiratory system compensates for metabolic acidosis by increasing ventilation to blow off CO2, lowering PaCO2.

Question 5

During cardiac arrest, which ventilation strategy is recommended by current AHA guidelines?

Accepted Answer

1 breath every 6 seconds asynchronous to compressions

Answer

After advanced airway placement, AHA recommends asynchronous ventilation at 10 breaths/min (one every 6 seconds) without interrupting compressions.

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