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The timing of a known clinical insult for ARDS needs to be within 2 weeks.
The timing of a known clinical insult for ARDS needs to be within 2 weeks.
False
Abdominal sepsis can be a cause of ARDS.
Abdominal sepsis can be a cause of ARDS.
True
Tidal volume in ARDS should be adjusted according to the patient's weight.
Tidal volume in ARDS should be adjusted according to the patient's weight.
True
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.
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ARDS generally includes the presence of lung edema.
ARDS generally includes the presence of lung edema.
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ARDS typically causes hypoxemia due to the presence of intrapulmonary right-to-left shunting.
ARDS typically causes hypoxemia due to the presence of intrapulmonary right-to-left shunting.
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ARDS generally causes an increase in respiratory system compliance.
ARDS generally causes an increase in respiratory system compliance.
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ARDS generally excludes the presence of lung edema due to increased capillary hydrostatic pressure.
ARDS generally excludes the presence of lung edema due to increased capillary hydrostatic pressure.
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Which of the following statements about the effectiveness of prone position during ARDS is/ are correct? (Select all that apply)
Which of the following statements about the effectiveness of prone position during ARDS is/ are correct? (Select all that apply)
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Prone position is effective only for patients with COVID-19 pneumonia.
Prone position is effective only for patients with COVID-19 pneumonia.
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A PaO2/FiO2 value higher than 150 mmHg is a criterion for considering prone position during ARDS.
A PaO2/FiO2 value higher than 150 mmHg is a criterion for considering prone position during ARDS.
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Prone position invariably improves hypoxemia despite a clear physiological mechanism in ARDS.
Prone position invariably improves hypoxemia despite a clear physiological mechanism in ARDS.
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The use of PEEP is always indicated in severe ARDS.
The use of PEEP is always indicated in severe ARDS.
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Effects of PEEP on lung density distribution in ARDS remain constant.
Effects of PEEP on lung density distribution in ARDS remain constant.
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High PEEP levels should be used to improve lung recruitment in ARDS.
High PEEP levels should be used to improve lung recruitment in ARDS.
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PEEP levels should not exceed 10 cmH2O in ARDS.
PEEP levels should not exceed 10 cmH2O in ARDS.
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PEEP can help reduce right-to-left intrapulmonary shunting, thus contributing to improved oxygenation in ARDS.
PEEP can help reduce right-to-left intrapulmonary shunting, thus contributing to improved oxygenation in ARDS.
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According to Stewart, the pH of the blood is independently regulated by pCO2, the Strong Ion Difference (SID), and the base excess (BE).
According to Stewart, the pH of the blood is independently regulated by pCO2, the Strong Ion Difference (SID), and the base excess (BE).
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The Strong Ion Difference (SID) is the difference between strong anions and strong cations.
The Strong Ion Difference (SID) is the difference between strong anions and strong cations.
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Hypoalbuminemia can cause metabolic acidosis.
Hypoalbuminemia can cause metabolic acidosis.
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Saline solution can cause hyperchloremic metabolic acidosis.
Saline solution can cause hyperchloremic metabolic acidosis.
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In chronic respiratory diseases, kidneys regulate the increase in HCO3- by removing Cl-
In chronic respiratory diseases, kidneys regulate the increase in HCO3- by removing Cl-
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Hypoalbuminemia itself is sufficient to cause alkalosis.
Hypoalbuminemia itself is sufficient to cause alkalosis.
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Chloride excretion is increased in respiratory acidosis.
Chloride excretion is increased in respiratory acidosis.
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PH is independently regulated by volatile acids, PCO2, and bicarbonate.
PH is independently regulated by volatile acids, PCO2, and bicarbonate.
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The Strong Ion Difference (SID) is equal to the difference between anions and cations.
The Strong Ion Difference (SID) is equal to the difference between anions and cations.
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The electrical neutrality, dissociation equilibrium, and mass conservation of all ions in the blood are governed by various laws.
The electrical neutrality, dissociation equilibrium, and mass conservation of all ions in the blood are governed by various laws.
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High pCO2 itself causes a decrease in bicarbonate.
High pCO2 itself causes a decrease in bicarbonate.
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An increase in ketone bodies leads to an increase in chloride levels.
An increase in ketone bodies leads to an increase in chloride levels.
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According to Stewart's approach to acid-base balance, pH is independently regulated by pCO2, Atot, and HCO3-.
According to Stewart's approach to acid-base balance, pH is independently regulated by pCO2, Atot, and HCO3-.
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Hypoalbuminemia by itself can cause metabolic alkalosis.
Hypoalbuminemia by itself can cause metabolic alkalosis.
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Ketoacidosis is caused by increased chloride concentrations in the blood.
Ketoacidosis is caused by increased chloride concentrations in the blood.
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In respiratory acidosis, an increase in PaCO2 leads to an immediate decrease in HCO3- concentration.
In respiratory acidosis, an increase in PaCO2 leads to an immediate decrease in HCO3- concentration.
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In respiratory acidosis, the body compensates for the increase in PaCO2 by increasing urinary excretion of chloride.
In respiratory acidosis, the body compensates for the increase in PaCO2 by increasing urinary excretion of chloride.
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In respiratory acidosis, pH is generally higher than 7.45.
In respiratory acidosis, pH is generally higher than 7.45.
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A patient with a femur fracture can lose up to 500 ml of blood.
A patient with a femur fracture can lose up to 500 ml of blood.
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The daily requirement for potassium is approximately 2-4 mmol/kg.
The daily requirement for potassium is approximately 2-4 mmol/kg.
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A plasma potassium level greater than 5.5 mmol/L always results in ECG abnormalities.
A plasma potassium level greater than 5.5 mmol/L always results in ECG abnormalities.
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Potassium supplementation should be initiated in patients with diabetic ketoacidosis (DKA) when their plasma potassium level drops below 3.5 mmol/L.
Potassium supplementation should be initiated in patients with diabetic ketoacidosis (DKA) when their plasma potassium level drops below 3.5 mmol/L.
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Rhabdomyolysis can lead to severe hyperkalemia
Rhabdomyolysis can lead to severe hyperkalemia
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Treatment of hypokalemia includes the administration of calcium chloride or calcium gluconate.
Treatment of hypokalemia includes the administration of calcium chloride or calcium gluconate.
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Sepsis is always associated with hyperlactatemia.
Sepsis is always associated with hyperlactatemia.
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Balancing fluids effectively helps to improve the acid-base equilibrium in septic shock.
Balancing fluids effectively helps to improve the acid-base equilibrium in septic shock.
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Patients with septic shock always have an elevated white blood cell count (WBC) above 10,000/µl.
Patients with septic shock always have an elevated white blood cell count (WBC) above 10,000/µl.
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Patients with septic shock always exhibit a decrease in urine output (oliguria).
Patients with septic shock always exhibit a decrease in urine output (oliguria).
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Patients with septic shock always present with clear signs of tissue hypoperfusion.
Patients with septic shock always present with clear signs of tissue hypoperfusion.
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A plasma lactate level around 1.5 mmol/L is typical in septic shock.
A plasma lactate level around 1.5 mmol/L is typical in septic shock.
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Septic shock can be diagnosed without identifying a clear source of infection.
Septic shock can be diagnosed without identifying a clear source of infection.
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Tension pneumothorax in a trauma patient is effectively treated by needle decompression in the fifth intercostal space, midclavicular line.
Tension pneumothorax in a trauma patient is effectively treated by needle decompression in the fifth intercostal space, midclavicular line.
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The first diagnostic test to be done in a traumatized patient is a CT scan.
The first diagnostic test to be done in a traumatized patient is a CT scan.
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In a traumatized patient, if there is bleeding, the first priority is to identify the source of the bleed and stop it.
In a traumatized patient, if there is bleeding, the first priority is to identify the source of the bleed and stop it.
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Hypothermia is always a concern in traumatized patients.
Hypothermia is always a concern in traumatized patients.
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Trauma patients are more prone to becoming hypothermic due to potential blood loss, which affects their body's ability to regulate temperature.
Trauma patients are more prone to becoming hypothermic due to potential blood loss, which affects their body's ability to regulate temperature.
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With a femur fracture, a patient can lose up to 500 ml of blood.
With a femur fracture, a patient can lose up to 500 ml of blood.
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In class IV hemorrhagic shock, a patient's blood loss is over 3 liters, and a blood transfusion using red blood cells (RBC) is indicated.
In class IV hemorrhagic shock, a patient's blood loss is over 3 liters, and a blood transfusion using red blood cells (RBC) is indicated.
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Evaluating the effectiveness of breathing and ventilation is a primary objective in phase B of ATLS management.
Evaluating the effectiveness of breathing and ventilation is a primary objective in phase B of ATLS management.
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Tension pneumothorax in a trauma patient must be confirmed with a chest X-ray before decompression.
Tension pneumothorax in a trauma patient must be confirmed with a chest X-ray before decompression.
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In a trauma patient with a flail chest and ineffective ventilation, positive-pressure ventilation should be implemented to improve oxygenation.
In a trauma patient with a flail chest and ineffective ventilation, positive-pressure ventilation should be implemented to improve oxygenation.
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An open pneumothorax in a trauma patient should be sealed with a sterile occlusive dressing before initiating any further interventions as part of the ATLS management.
An open pneumothorax in a trauma patient should be sealed with a sterile occlusive dressing before initiating any further interventions as part of the ATLS management.
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A simple pneumothorax in a trauma patient should be treated before initiating phase C, D, or E of ATLS management.
A simple pneumothorax in a trauma patient should be treated before initiating phase C, D, or E of ATLS management.
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Hemodynamic instability in a trauma patient with abdominal trauma can be ruled out by a normal systolic blood pressure.
Hemodynamic instability in a trauma patient with abdominal trauma can be ruled out by a normal systolic blood pressure.
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In a trauma patient with abdominal trauma, a CT scan is the primary diagnostic test for determining hemodynamic instability when a patient is exhibiting clinical instability.
In a trauma patient with abdominal trauma, a CT scan is the primary diagnostic test for determining hemodynamic instability when a patient is exhibiting clinical instability.
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A normal heart rate in a trauma patient automatically excludes the possibility of a clinically relevant hemorrhage.
A normal heart rate in a trauma patient automatically excludes the possibility of a clinically relevant hemorrhage.
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Hypothermia can worsen bleeding in a trauma patient.
Hypothermia can worsen bleeding in a trauma patient.
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Bleeding source identification and control are the initial steps in managing a trauma patient's hemorrhage during phase C of ATLS.
Bleeding source identification and control are the initial steps in managing a trauma patient's hemorrhage during phase C of ATLS.
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Emergency airway management is indicated in a patient with severe traumatic brain injury.
Emergency airway management is indicated in a patient with severe traumatic brain injury.
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Severe hypoxemia is the primary cause of intubation complications in critically-ill patients.
Severe hypoxemia is the primary cause of intubation complications in critically-ill patients.
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Auscultation is the best way to confirm successful endotracheal intubation.
Auscultation is the best way to confirm successful endotracheal intubation.
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Propofol is the best induction agent for intubation in critically ill patients.
Propofol is the best induction agent for intubation in critically ill patients.
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Video laryngoscopy can increase the success rate of intubation.
Video laryngoscopy can increase the success rate of intubation.
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Ringer Lactate administration always leads to metabolic alkalosis.
Ringer Lactate administration always leads to metabolic alkalosis.
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Ringer Lactate administration typically leads to a clinically relevant increase in plasma lactate concentration.
Ringer Lactate administration typically leads to a clinically relevant increase in plasma lactate concentration.
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Ringer Lactate can have a negative impact on renal function.
Ringer Lactate can have a negative impact on renal function.
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Ringer Lactate is contraindicated in patients with traumatic brain injury.
Ringer Lactate is contraindicated in patients with traumatic brain injury.
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Ringer Lactate administration in large quantities can cause hypernatremia (high sodium levels).
Ringer Lactate administration in large quantities can cause hypernatremia (high sodium levels).
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Colloid-containing solutions are indicated for hemorrhagic shock in critically ill patients.
Colloid-containing solutions are indicated for hemorrhagic shock in critically ill patients.
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Colloid-containing solutions are appropriate in cases of sepsis in critically ill patients.
Colloid-containing solutions are appropriate in cases of sepsis in critically ill patients.
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Colloid-containing solutions are not indicated in patients with traumatic brain injury.
Colloid-containing solutions are not indicated in patients with traumatic brain injury.
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Colloid-containing solutions are contraindicated when referring to synthetic colloids.
Colloid-containing solutions are contraindicated when referring to synthetic colloids.
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Colloid-containing solutions are beneficial in maintaining cerebral perfusion pressure in patients with traumatic brain injury.
Colloid-containing solutions are beneficial in maintaining cerebral perfusion pressure in patients with traumatic brain injury.
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Colloid-containing solutions containing albumin are beneficial during septic shock.
Colloid-containing solutions containing albumin are beneficial during septic shock.
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Ringer Lactate administration increases the sodium (Na) level in the blood.
Ringer Lactate administration increases the sodium (Na) level in the blood.
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Ringer Lactate administration does not increase the lactate level in the blood at physiological levels.
Ringer Lactate administration does not increase the lactate level in the blood at physiological levels.
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Ringer Lactate administration does not cause metabolic acidosis.
Ringer Lactate administration does not cause metabolic acidosis.
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The primary objective of normal water balance is to maintain the volume and osmolality of both the extracellular and intracellular spaces within the body.
The primary objective of normal water balance is to maintain the volume and osmolality of both the extracellular and intracellular spaces within the body.
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Approximately 60% of our body weight is composed of water.
Approximately 60% of our body weight is composed of water.
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Antidiuretic hormone (ADH) is a potent regulator of both volume and osmolality in the body.
Antidiuretic hormone (ADH) is a potent regulator of both volume and osmolality in the body.
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The minimal amount of water that should be excreted daily in a healthy individual is about 1 liter.
The minimal amount of water that should be excreted daily in a healthy individual is about 1 liter.
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The most representative anion within the intracellular space is H2PO4-.
The most representative anion within the intracellular space is H2PO4-.
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In patients with severe respiratory failure associated with COVID-19 pneumonia, respiratory system compliance is generally higher compared to classical ARDS.
In patients with severe respiratory failure associated with COVID-19 pneumonia, respiratory system compliance is generally higher compared to classical ARDS.
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Hypoxemia in COVID-19 pneumonia may result from an alteration of the normal distribution of lung perfusion.
Hypoxemia in COVID-19 pneumonia may result from an alteration of the normal distribution of lung perfusion.
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Respiratory support should be considered only when a respiratory arrest is imminent in patients with severe respiratory failure related to COVID-19 pneumonia.
Respiratory support should be considered only when a respiratory arrest is imminent in patients with severe respiratory failure related to COVID-19 pneumonia.
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High levels of transpulmonary pressure are only used during invasive mechanical ventilation to help overcome resistance in the lungs.
High levels of transpulmonary pressure are only used during invasive mechanical ventilation to help overcome resistance in the lungs.
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The current WHO international guidelines endorse the use of IL-6 receptor blockers in the management of COVID-19 pneumonia.
The current WHO international guidelines endorse the use of IL-6 receptor blockers in the management of COVID-19 pneumonia.
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A central venous oxygen saturation (ScvO2) of 45 percent in a critically ill patient may reflect impaired oxygen delivery.
A central venous oxygen saturation (ScvO2) of 45 percent in a critically ill patient may reflect impaired oxygen delivery.
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Cardiogenic shock is the most common type of shock in the general Intensive Care Unit (ICU) population.
Cardiogenic shock is the most common type of shock in the general Intensive Care Unit (ICU) population.
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Both fast and slow heart rates can be associated with hypoperfusion.
Both fast and slow heart rates can be associated with hypoperfusion.
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A normal capillary refill time (CRT) always excludes the possibility of a clinically relevant hemorrhage.
A normal capillary refill time (CRT) always excludes the possibility of a clinically relevant hemorrhage.
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Anaphylaxis is the most common type of distributive shock.
Anaphylaxis is the most common type of distributive shock.
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Study Notes
Anesthesiology VV - ARDS
- ARDS timing is typically within 2 weeks of insult, though 1 week is also a possibility.
- Abdominal sepsis can cause ARDS.
- Tidal volume must be adjusted to patient weight at 5ml/kg.
- ARDS generally involves lung edema and increased permeability of alveolar capillary membranes.
- COVID-19 pneumonia pathophysiology is not directly similar to ARDS.
- ARDS usually reduces respiratory system compliance.
- ARDS generally doesn't involve increased capillary hydrostatic pressure in the pulmonary circulation.
ARDS Prone Position
- Prone position is not always effective in COVID-19 pneumonia.
- Prone position may not be recommended if PaO2/FiO2 > 150 mmHg.
- Prone position may improve hypoxemia in severe ARDS, despite unclear mechanism.
- Prone position for ARDS is broadly applied.
- Prone positioning often redistributes lung density.
ARDS and PEЕР
- PEЕР is generally indicated in severe ARDS.
- Effects of PEЕР depend on lung density distribution.
- High levels of PEЕР are used to potentially recruit lung tissue.
- PEЕР should not exceed 10 cmH2O.
- PEЕР may improve hypoxemia by reducing intrapulmonary shunting.
Acid-Base Equilibrium
- Stewart's approach to acid-base balance states pH is regulated by pCO2, strong ions, and SID.
- SID is the difference between strong cations and strong anions.
- Hypoalbuminemia can cause metabolic alkalosis, not acidosis.
- Isotonic saline solution can lead to hyperchloremic metabolic acidosis.
- In respiratory acidosis, the kidneys compensate by reducing bicarbonate and increasing chloride excretion.
- Chloride excretion is increased in respiratory acidosis.
- Hypoalbuminemia itself can cause alkalosis without other factors.
Potassium Metabolism
- Daily potassium requirement is approximately 2-4 mmol/kg.
- Plasma K+ levels > 5.5 mmol/L may be associated with ECG changes but not always.
- K+ supplementation in DKA should start when K+ is lower than 3.5 mmol/L (False).
- Rhabdomyolysis can cause hyperkalemia.
- Hypokalemia treatment involves administering CaCl or Ca gluconate.
Sepsis
- Sepsis is not always associated with hyperlactatemia.
- Fluid management is beneficial in managing acid-base disturbances in septic shock.
- White blood cell counts aren't always elevated in septic shock.
- Septic shock may show signs of altered tissue perfusion.
- May not show a clear organ infection site in sepsis.
ATLS
- Tension pneumothorax treatment involves decompression in the midclavicular line, 5th intercostal space (False).
- Correct procedure is a needle decompression using the 2nd intercostal space, midclavicular line.
- Flail chest is suspected when chest expansion and diaphragm movement are inconsistent and impair breathing.
- Initial diagnostic for trauma is typically physical exam.
- With bleeding, the priority is to identify and stop the source to stabilize the patient.
Fluid Therapy, Intravenous Administration of Ringer Lactate
- Use of Ringer's lactate does not always lead to metabolic alkalosis.
- Ringer's lactate generally does not have a clinically significant effect on plasma lactate concentration.
- Use of Ringer's lactate should not be used routinely in patients with traumatic brain injury (False).
- The use of Ringer's lactate is not indicated for all cases of intravascular fluid requirements.
- Ringer's lactate in high quantities may cause hypernatremia.
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Description
This quiz covers essential aspects of Acute Respiratory Distress Syndrome (ARDS), including its timing, causes, and mechanical ventilation strategies. It also discusses the role of prone positioning and the indications for PEER in the management of severe ARDS. Test your understanding of these critical concepts in anesthesiology.
