Technological and Procedural Proficiency Flashcards
7 cards from real ACCS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Technological and Procedural Proficiency flashcards as text
When performing a bronchoscopy-guided percutaneous tracheostomy, which landmark is most critical to identify before dilation?
Answer: Tracheal rings 2-3 interspace
The 2-3 tracheal ring interspace is the preferred insertion site for percutaneous tracheostomy to avoid damage to the cricoid cartilage and subglottic stenosis.
A patient on volume-controlled ventilation develops a sudden increase in peak airway pressure with unchanged plateau pressure. What is the most likely cause?
Answer: Increased secretions or bronchospasm
An isolated rise in peak pressure with stable plateau pressure indicates increased airway resistance, most commonly due to secretions or bronchospasm rather than parenchymal changes.
During placement of a pulmonary artery catheter, the waveform transitions from a right ventricular trace to a pulmonary artery waveform. Which change confirms this transition?
Answer: Appearance of a dicrotic notch and elevated diastolic pressure
The pulmonary artery waveform shows a dicrotic notch and a higher diastolic value than the RV, confirming passage through the pulmonic valve.
Which ventilator setting is MOST directly associated with ventilator-induced lung injury (VILI) in ARDS patients?
Answer: Tidal volume > 8 mL/kg IBW
Volutrauma from excessive tidal volumes (>8 mL/kg IBW) is the primary driver of VILI; ARDSNet protocols target 6 mL/kg IBW to reduce stretch injury.
An ICU patient's arterial line waveform shows marked respiratory variation in pulse pressure (>13%). What does this most likely indicate?
Answer: Fluid responsiveness in a mechanically ventilated patient
Pulse pressure variation >13% during mechanical ventilation correlates strongly with preload dependence and predicts fluid responsiveness.
During continuous renal replacement therapy (CRRT), a sudden rise in transmembrane pressure (TMP) most likely indicates:
Answer: Filter clotting
Rising TMP signals increasing resistance across the hemofilter membrane, most commonly caused by clot formation in the filter.
When using ultrasound to place a central venous catheter in the internal jugular vein, which maneuver best distinguishes the vein from the carotid artery?
Answer: Applying gentle probe compression to collapse the vessel
Gentle probe compression collapses the compliant vein but not the pulsatile, high-pressure carotid artery, reliably distinguishing the two.