RRT Ultimate Flashcards

A patient on volume-controlled ventilation has a sudden rise in peak airway pressure with no change in plateau pressure. What is the most likely cause?

Answer: Increased secretions in the airway

A rise in peak pressure with an unchanged plateau pressure indicates increased airway resistance, most commonly from secretions.

Which arterial blood gas pattern is consistent with acute respiratory acidosis?

Answer: pH 7.30, PaCO2 58, HCO3 27

Acute respiratory acidosis shows low pH and elevated PaCO2 with near-normal bicarbonate (little renal compensation yet).

A patient is receiving 60% FiO2 via mechanical ventilator. ABG shows PaO2 of 65 mmHg. What is the calculated P/F ratio?

Answer: 108

P/F ratio = PaO2 / FiO2 = 65 / 0.60 = 108, indicating severe hypoxemia consistent with ARDS.

Which of the following is the MOST appropriate initial ventilator setting for a 70 kg IBW patient with ARDS?

Answer: Tidal volume 420 mL, RR 18

ARDSnet protocol recommends 6 mL/kg IBW, so 70 kg × 6 = 420 mL with a higher RR to maintain adequate ventilation.

A patient's spontaneous breathing trial (SBT) is terminated after 15 minutes due to RR of 36 and SpO2 of 88%. What is the BEST next step?

Answer: Resume full ventilatory support and reassess in 24 hours

A failed SBT warrants returning to full support; 24 hours of recovery is recommended before the next attempt.

Which drug is used to reverse neuromuscular blockade caused by vecuronium?

Answer: Neostigmine

Neostigmine (an anticholinesterase) reverses non-depolarizing neuromuscular blockers like vecuronium.

What is the primary indication for prone positioning in a mechanically ventilated patient?

Answer: Moderate-to-severe ARDS with P/F ratio < 150

Prone positioning improves V/Q matching and oxygenation in moderate-to-severe ARDS (P/F < 150 on adequate PEEP).