RRT Clinical Concepts Flashcards

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

Answer: Begin prophylactic intubation

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

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

Answer: Cardiogenic pulmonary edema

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

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

Answer: Decreased lung compliance

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

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

Answer: Decreased PaCO2

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

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

Answer: 1 breath every 6 seconds asynchronous to compressions

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

A patient's flow-volume loop shows a fixed plateau on both inspiration and expiration. This pattern is most consistent with:

Answer: Fixed upper airway obstruction

A fixed upper airway obstruction truncates both the inspiratory and expiratory limbs equally, producing a box-shaped flow-volume loop.

Which finding on a capnography waveform suggests esophageal intubation?

Answer: Absent CO2 waveform (near zero reading)

Esophageal intubation produces no sustained CO2 waveform since there is no alveolar CO2 being exhaled through the tube.