Podcast
Questions and Answers
Timing of a known clinical insult within 2 weeks is a characteristic of ARDS.
Timing of a known clinical insult within 2 weeks is a characteristic of ARDS.
- False (correct)
- True
Abdominal sepsis may be a cause of ARDS.
Abdominal sepsis may be a cause of ARDS.
- False
- True (correct)
Tidal volume should be adjusted accordingly to the weight of the patient.
Tidal volume should be adjusted accordingly to the weight of the patient.
- True (correct)
- False
ARDS includes the presence of lung edema, increased permeability of the alveolar capillary membrane, and hypoxemia due to intra-pulmonary right-to-left shunting.
ARDS includes the presence of lung edema, increased permeability of the alveolar capillary membrane, and hypoxemia due to intra-pulmonary right-to-left shunting.
The pathophysiology of ARDS is similar to the pathophysiology of COVID-19 pneumonia.
The pathophysiology of ARDS is similar to the pathophysiology of COVID-19 pneumonia.
ARDS causes hypoxemia due to intra-pulmonary right-to-left shunting.
ARDS causes hypoxemia due to intra-pulmonary right-to-left shunting.
ARDS causes an increase in respiratory system compliance.
ARDS causes an increase in respiratory system compliance.
ARDS generally excludes the presence of lung edema due to increased capillary hydrostatic pressure of the pulmonary circulation.
ARDS generally excludes the presence of lung edema due to increased capillary hydrostatic pressure of the pulmonary circulation.
The use of prone position during ARDS is effective only in case of COVID-19 pneumonia.
The use of prone position during ARDS is effective only in case of COVID-19 pneumonia.
The use of prone position during ARDS should be considered in patients with a PaO2/FiO2 value higher than 150 mmHg.
The use of prone position during ARDS should be considered in patients with a PaO2/FiO2 value higher than 150 mmHg.
Prone positioning during ARDS often causes an improvement of hypoxemia despite a clear pathophysiological mechanism.
Prone positioning during ARDS often causes an improvement of hypoxemia despite a clear pathophysiological mechanism.
Prone positioning during ARDS is widely applied worldwide.
Prone positioning during ARDS is widely applied worldwide.
Prone positioning during ARDS normally induces a redistribution of lung densities towards the dependent lung regions.
Prone positioning during ARDS normally induces a redistribution of lung densities towards the dependent lung regions.
PEEP is always indicated in severe ARDS patients.
PEEP is always indicated in severe ARDS patients.
The effects of PEEP in severe ARDS patients depend on the distribution of lung densities.
The effects of PEEP in severe ARDS patients depend on the distribution of lung densities.
High levels of PEEP should be based on the potential for lung recruitment.
High levels of PEEP should be based on the potential for lung recruitment.
PEEP should not exceed 10 cmH2O.
PEEP should not exceed 10 cmH2O.
PEEP may correct hypoxemia by reducing the amount of right to left intrapulmonary shunting.
PEEP may correct hypoxemia by reducing the amount of right to left intrapulmonary shunting.
According to Stewart's theory, pH is independently regulated by pCO2, A-, and SID.
According to Stewart's theory, pH is independently regulated by pCO2, A-, and SID.
The strong ion difference (SID) is the difference between strong cations and strong anions.
The strong ion difference (SID) is the difference between strong cations and strong anions.
Hypoalbuminemia may lead to metabolic acidosis.
Hypoalbuminemia may lead to metabolic acidosis.
Saline solution can cause hyperchloremic metabolic acidosis.
Saline solution can cause hyperchloremic metabolic acidosis.
Kidneys compensate for the increase in HCO3- in chronic respiratory diseases by removing chloride.
Kidneys compensate for the increase in HCO3- in chronic respiratory diseases by removing chloride.
Hypoalbuminemia alone can cause metabolic alkalosis.
Hypoalbuminemia alone can cause metabolic alkalosis.
Chloride excretion is increased in respiratory acidosis.
Chloride excretion is increased in respiratory acidosis.
PH is independently regulated by volatile acids, pCO2, and bicarbonate.
PH is independently regulated by volatile acids, pCO2, and bicarbonate.
SID is equal to the difference between anions and cations.
SID is equal to the difference between anions and cations.
The principle of electrical neutrality, dissociation equilibrium, and mass conservation all apply to acid-base balance.
The principle of electrical neutrality, dissociation equilibrium, and mass conservation all apply to acid-base balance.
High PCO2, per se, causes a decrease in bicarbonate.
High PCO2, per se, causes a decrease in bicarbonate.
Accumulation of ketone bodies leads to an increase in chloride concentration.
Accumulation of ketone bodies leads to an increase in chloride concentration.
According to Stewart's theory, pH is independently regulated by pCO2, Atot, and HCO3-.
According to Stewart's theory, pH is independently regulated by pCO2, Atot, and HCO3-.
Hypoalbuminemia can lead to development of metabolic alkalosis.
Hypoalbuminemia can lead to development of metabolic alkalosis.
Ketoacidosis is due to an increase in chloride concentration.
Ketoacidosis is due to an increase in chloride concentration.
During respiratory acidosis, the increase in PaCO2, per se, leads to a reduction in HCO3- concentration.
During respiratory acidosis, the increase in PaCO2, per se, leads to a reduction in HCO3- concentration.
In chronic respiratory acidosis, the renal system increases urinary excretion of chloride as a compensation.
In chronic respiratory acidosis, the renal system increases urinary excretion of chloride as a compensation.
PH is usually higher than 7.45 during respiratory acidosis.
PH is usually higher than 7.45 during respiratory acidosis.
The daily requirement for potassium is about 2-4 mmol/kg.
The daily requirement for potassium is about 2-4 mmol/kg.
A plasma potassium level greater than 5.5 mmol/L is always associated with ECG alterations.
A plasma potassium level greater than 5.5 mmol/L is always associated with ECG alterations.
Potassium supplementation should be started during DKA treatment when plasma potassium concentration is lower than 3.5 mmol/L.
Potassium supplementation should be started during DKA treatment when plasma potassium concentration is lower than 3.5 mmol/L.
Rhabdomyolysis can cause severe hyperkalemia.
Rhabdomyolysis can cause severe hyperkalemia.
Treatment of hypokalemia includes the administration of Ca-Cl or Ca-gluconate.
Treatment of hypokalemia includes the administration of Ca-Cl or Ca-gluconate.
Sepsis is always associated with hyperlactatemia.
Sepsis is always associated with hyperlactatemia.
Fluid balance is better than IV antibiotics for correcting acid-base imbalance during sepsis.
Fluid balance is better than IV antibiotics for correcting acid-base imbalance during sepsis.
Patients with septic shock will always be oliguric.
Patients with septic shock will always be oliguric.
Patients with septic shock always have WBC counts greater than 10,000/µL.
Patients with septic shock always have WBC counts greater than 10,000/µL.
Septic shock generally presents some signs of altered tissue hypoperfusion.
Septic shock generally presents some signs of altered tissue hypoperfusion.
Patients with septic shock may have a plasma lactate level of about 1.5 mmol/L.
Patients with septic shock may have a plasma lactate level of about 1.5 mmol/L.
Patients with septic shock may not have a clear site of infection.
Patients with septic shock may not have a clear site of infection.
Tension pneumothorax is treated with decompression in the 5th intercostal space, midclavicular line.
Tension pneumothorax is treated with decompression in the 5th intercostal space, midclavicular line.
CT scan is the first diagnostic test in a traumatized patient.
CT scan is the first diagnostic test in a traumatized patient.
If a patient is bleeding, the first step is to identify and control the source of bleeding.
If a patient is bleeding, the first step is to identify and control the source of bleeding.
Hypothermia is a common problem in trauma patients.
Hypothermia is a common problem in trauma patients.
With a femur fracture, blood loss can be up to 500 ml.
With a femur fracture, blood loss can be up to 500 ml.
RBC transfusion is indicated in class IV trauma patients.
RBC transfusion is indicated in class IV trauma patients.
During the B phase of ATLS, it is necessary to evaluate the effectiveness of breathing and ventilation.
During the B phase of ATLS, it is necessary to evaluate the effectiveness of breathing and ventilation.
Tension pneumothorax should be confirmed with chest X-ray before decompression.
Tension pneumothorax should be confirmed with chest X-ray before decompression.
Positive pressure ventilation should be applied in cases of flail chest and ineffective ventilation.
Positive pressure ventilation should be applied in cases of flail chest and ineffective ventilation.
Open pneumothorax should be treated by tightly closing the opening with a sterile occlusive dressing.
Open pneumothorax should be treated by tightly closing the opening with a sterile occlusive dressing.
Simple pneumothorax should be treated before moving on to phases C, D, and E of ATLS.
Simple pneumothorax should be treated before moving on to phases C, D, and E of ATLS.
Hemorrhagic shock can be excluded if systolic blood pressure is within normal range.
Hemorrhagic shock can be excluded if systolic blood pressure is within normal range.
In a patient with abdominal trauma and hemodynamic instability, CT scan is the first line diagnostic test.
In a patient with abdominal trauma and hemodynamic instability, CT scan is the first line diagnostic test.
A normal heart rate always excludes the possibility of clinically relevant hemorrhage.
A normal heart rate always excludes the possibility of clinically relevant hemorrhage.
Hypothermia can worsen bleeding.
Hypothermia can worsen bleeding.
Identifying the source of bleeding and managing it is the first step in the C phase of ATLS.
Identifying the source of bleeding and managing it is the first step in the C phase of ATLS.
Emergency airway management is necessary in severe traumatic brain injury.
Emergency airway management is necessary in severe traumatic brain injury.
Severe hypoxemia is the leading complication of intubation in critically ill patients.
Severe hypoxemia is the leading complication of intubation in critically ill patients.
Auscultation is the best method to confirm the success of endotracheal intubation.
Auscultation is the best method to confirm the success of endotracheal intubation.
Propofol is the best induction agent for critically ill patients.
Propofol is the best induction agent for critically ill patients.
Video laryngoscopy can help to increase success of intubation.
Video laryngoscopy can help to increase success of intubation.
Intravenous administration of Ringer lactate always leads to metabolic alkalosis.
Intravenous administration of Ringer lactate always leads to metabolic alkalosis.
Ringer lactate generally does not lead to a clinically relevant increase in plasma lactate concentration.
Ringer lactate generally does not lead to a clinically relevant increase in plasma lactate concentration.
Ringer lactate can be detrimental to renal function.
Ringer lactate can be detrimental to renal function.
Ringer lactate is not indicated in patients with traumatic brain injury.
Ringer lactate is not indicated in patients with traumatic brain injury.
Large volumes of Ringer lactate can cause hypernatremia.
Large volumes of Ringer lactate can cause hypernatremia.
Colloid-containing solutions are indicated in cases of hemorrhage with the use of HES.
Colloid-containing solutions are indicated in cases of hemorrhage with the use of HES.
The use of colloid-containing solutions is generally not indicated in critically ill patients when referring to synthetic colloids.
The use of colloid-containing solutions is generally not indicated in critically ill patients when referring to synthetic colloids.
Colloid-containing solutions are indicated during traumatic brain injury to maintain cerebral perfusion pressure.
Colloid-containing solutions are indicated during traumatic brain injury to maintain cerebral perfusion pressure.
Colloid-containing solutions are indicated in sepsis to manage severe hypovolemia.
Colloid-containing solutions are indicated in sepsis to manage severe hypovolemia.
Albumin is beneficial in patients with septic shock.
Albumin is beneficial in patients with septic shock.
Intravenous Ringer lactate is not indicated during septic shock.
Intravenous Ringer lactate is not indicated during septic shock.
Intravenous Ringer lactate increases sodium levels.
Intravenous Ringer lactate increases sodium levels.
Intravenous Ringer lactate does not increase lactate levels at physiological concentrations.
Intravenous Ringer lactate does not increase lactate levels at physiological concentrations.
Intravenous Ringer lactate does not cause acidosis.
Intravenous Ringer lactate does not cause acidosis.
The goal of normal water balance is to maintain the volemia and osmolality of the extracellular and intracellular spaces.
The goal of normal water balance is to maintain the volemia and osmolality of the extracellular and intracellular spaces.
Approximately 60% of body weight is made up of water.
Approximately 60% of body weight is made up of water.
ADH is a powerful regulator of both osmolality and volume.
ADH is a powerful regulator of both osmolality and volume.
The minimum amount of water that should be excreted daily in urine is approximately 1 liter.
The minimum amount of water that should be excreted daily in urine is approximately 1 liter.
The most representative anion within the intracellular space is H2PO4.
The most representative anion within the intracellular space is H2PO4.
Respiratory system compliance is generally higher in COVID-19 pneumonia with severe respiratory failure compared to classical ARDS.
Respiratory system compliance is generally higher in COVID-19 pneumonia with severe respiratory failure compared to classical ARDS.
Hypoxemia in COVID-19 pneumonia with severe respiratory failure can result from an alteration of the normal distribution of lung perfusion.
Hypoxemia in COVID-19 pneumonia with severe respiratory failure can result from an alteration of the normal distribution of lung perfusion.
Respiratory support for COVID-19 pneumonia with severe respiratory failure should only be considered when respiratory arrest is imminent.
Respiratory support for COVID-19 pneumonia with severe respiratory failure should only be considered when respiratory arrest is imminent.
High levels of transpulmonary pressure only occur during invasive mechanical ventilation.
High levels of transpulmonary pressure only occur during invasive mechanical ventilation.
IL-6 receptor blockers are now included in the current WHO international guidelines for treating COVID-19 pneumonia.
IL-6 receptor blockers are now included in the current WHO international guidelines for treating COVID-19 pneumonia.
A central vein oxygen saturation (ScvO2) of 45% may indicate impaired oxygen delivery.
A central vein oxygen saturation (ScvO2) of 45% may indicate impaired oxygen delivery.
Cardiogenic shock is the most common type of shock seen in the general ICU population.
Cardiogenic shock is the most common type of shock seen in the general ICU population.
Both high and low heart rates can be associated with hypoperfusion.
Both high and low heart rates can be associated with hypoperfusion.
A capillary refill time is always normal with a systolic arterial pressure of 130 mmHg.
A capillary refill time is always normal with a systolic arterial pressure of 130 mmHg.
Anaphylaxis is the most common form of distributive shock.
Anaphylaxis is the most common form of distributive shock.
A patient with supraventricular tachycardia (160 bpm) should receive fluids to improve systemic perfusion.
A patient with supraventricular tachycardia (160 bpm) should receive fluids to improve systemic perfusion.
Cardioversion is the best treatment option for supraventricular tachycardia if associated with signs of hypoperfusion.
Cardioversion is the best treatment option for supraventricular tachycardia if associated with signs of hypoperfusion.
Flashcards
ARDS Timing
ARDS Timing
A known clinical insult within 2 weeks (approximately 1 week) often precedes ARDS.
ARDS Cause: Abdominal Sepsis
ARDS Cause: Abdominal Sepsis
Abdominal sepsis can be a cause of acute respiratory distress syndrome (ARDS).
ARDS Tidal Volume
ARDS Tidal Volume
Tidal volume adjustment based on the patient's weight (5ml/kg) is important in ARDS.
ARDS Lung Edema
ARDS Lung Edema
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ARDS and COVID-19
ARDS and COVID-19
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ARDS Hypoxemia
ARDS Hypoxemia
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ARDS Respiratory Compliance
ARDS Respiratory Compliance
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ARDS and Hydrostatic Pressure
ARDS and Hydrostatic Pressure
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Prone Position and ARDS
Prone Position and ARDS
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PEEP in ARDS
PEEP in ARDS
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PEEP Adjustment
PEEP Adjustment
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Acid-Base: Stewart
Acid-Base: Stewart
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Strong Ions Difference (SID)
Strong Ions Difference (SID)
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Hypoalbuminemia and Acidosis
Hypoalbuminemia and Acidosis
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Saline and Acidosis
Saline and Acidosis
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Respiratory Acidosis Compensation
Respiratory Acidosis Compensation
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Hypoalbuminemia and Alkalosis
Hypoalbuminemia and Alkalosis
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Respiratory Acidosis Chloride
Respiratory Acidosis Chloride
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Acid-Base Regulation
Acid-Base Regulation
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SID and Anions/Cations
SID and Anions/Cations
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Study Notes
Anesthesiology VV - ARDS
- ARDS timing is usually within 2 weeks of insult, not 1 week
- Abdominal sepsis can cause ARDS
- Tidal volume adjustment is weight-dependent (5 ml/kg)
- ARDS is associated with alveolar-capillary membrane permeability increase.
- COVID-19 pneumonia pathophysiology is not similar to ARDS
- ARDS reduces respiratory compliance, typically not lung edema from increased capillary hydrostatic pressure.
- Prone position in ARDS is effective, not limited to COVID-19 pneumonia
- Prone position redistributes lung densities to dependent regions
- ARDS PEЕРapplication is generally indicated—level based on lung recruitment potential; not exceeding 10 cmH2O.
- PEЕРcan correct hypoxemia by reducing right-to-left shunting.
Acid-base Equilibrium
- pH is independently regulated by pCO2, strong cation–strong anion difference (SID), and strong acids and bases.
- SID (strong ion difference) is the difference between strong cations and strong anions.
- Hypoalbuminemia can cause metabolic alkalosis (not acidosis.)
- Saline solution can cause hyperchloremic metabolic acidosis on its own.
- Chloride excretion increases in respiratory acidosis to compensate for HCO3- loss.
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Description
This quiz covers critical concepts in anesthesiology, focusing on Acute Respiratory Distress Syndrome (ARDS) and acid-base equilibrium. It explores the causes, physiological changes, and management strategies for ARDS, including the role of prone positioning and PEER application. Additionally, it delves into the regulation of pH and strong ion difference in acid-base balance.
