Carbon Monoxide Poisoning Overview

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Questions and Answers

What increase in FEV1 in post-bronchodilator spirometry is needed to confirm reversibility of an obstructive pattern?

15% and 100 mL

10% and 100 mL

20% and 200 mL

12% and 200 mL (correct)

A patient with a history of asthma presents to the ED in severe respiratory distress and increased accessory muscle use. What should the respiratory therapist recommend initiating?

Pulmacort® by small volume nebulizer

Salmeterol® by DPI

Ventolin® by continuous nebulization (correct)

Xopenex® by MDI

A patient in the ICU is being ventilated with PC, SIMV with a set inspiratory pressure of 62 cm H2O. What should the therapist do if over-distension is noted?

Decrease the respiratory rate

Increase the expiratory time

Decrease the PEEP

Decrease the inspiratory pressure (correct)

An adult patient with asthma is receiving a mixture of 70% helium and 30% oxygen through a non-rebreathing mask. What is the actual flow being delivered to the mask?

16 L/min Signup and view all the answers

Which of the following should the respiratory therapist utilize to determine the severity of respiratory distress in a newborn?

Silverman score Signup and view all the answers

While administering 3.5 mg of albuterol, the patient's heart rate increases from 120 to 150 beats/minute. What is the appropriate modification for the next treatment?

Reduce the dose of albuterol Signup and view all the answers

Which neuromuscular blocker has a fast onset and short duration that the therapist should recommend?

Succinylcholine Signup and view all the answers

What should the respiratory therapist do if the capnometer suddenly indicates an abrupt decrease in PETCO2 from 5.3% to 0.0%?

Reattach the patient to the circuit Signup and view all the answers

What is the major cause of hypoxemia in this patient?

Ventilation/perfusion mismatch Signup and view all the answers

Which bronchial hygiene therapy is most appropriate for a 16-year-old patient with cystic fibrosis?

Vibratory / oscillatory PEP Signup and view all the answers

How should the respiratory therapist document a patient's difficulty breathing while lying down?

Orthopnea Signup and view all the answers

What should be done if oxygen supply tubing does not stay attached to a transtracheal catheter?

Switch to a nasal cannula Signup and view all the answers

In a patient with copious secretions requiring nasotracheal suctioning who develops mild epistaxis, what should the therapist recommend?

Insert a nasopharyngeal airway after bleeding is controlled Signup and view all the answers

What is the most probable cause of air bronchograms and increased density on a chest X-ray?

Pneumonia Signup and view all the answers

What should the respiratory therapist recommend for a post-operative patient with stable vital signs but low PvO2?

Increase the FIO2 Signup and view all the answers

What is the primary source of infection in the healthcare setting?

Poor handwashing techniques of personnel Signup and view all the answers

What should be recommended for a post-operative patient with pneumonia and crackles in both lungs?

Regular coughing and deep breathing Signup and view all the answers

What is the next step after obtaining a blood gas sample from a patient's radial artery?

Placing the syringe in an ice bath Signup and view all the answers

Which finding is LEAST compatible with hyperlucency on a chest X-ray?

Increased fremitus Signup and view all the answers

What is the most appropriate recommendation after a spontaneous breathing trial on an intubated patient?

Extubate the patient Signup and view all the answers

What is the appropriate postural drainage position for a patient with infiltrates in the lower lobes?

Head down, patient prone with a pillow under hips Signup and view all the answers

What is the patient's possible condition with a BNP of 700 pg/mL?

Moderate heart failure Signup and view all the answers

What do diminished breath sounds in the left lung indicate after blunt chest trauma?

Endobronchial intubation Signup and view all the answers

What should be recommended for a post-operative patient with decreased chest expansion?

Lung expansion therapy Signup and view all the answers

What does a cuff pressure of 42 cm H2O indicate in a patient with a high-residual-volume cuff?

Tube is not of the appropriate size Signup and view all the answers

What is the most likely explanation for a patient receiving oxygen via nasal cannula at 2 L/min and having low PaO2?

Numbers not reported correctly Signup and view all the answers

What solution is most appropriate for disinfecting a pulse oximeter between patients?

70% ethyl alcohol Signup and view all the answers

What is the most likely etiology for a patient with tachypnea and tracheal deviation?

Left tension pneumothorax Signup and view all the answers

What is the most serious complication associated with airway suctioning?

Hypoxemia Signup and view all the answers

What is the most appropriate position for a patient who is 5'3", weighs 200 kg, and has difficulty breathing?

Lateral Fowlers Signup and view all the answers

Which arterial carbon dioxide tension value is consistent with significant alveolar hypoventilation?

50 torr Signup and view all the answers

Which statement regarding cuff inflation techniques is NOT true?

Minimal leak/minimal occlusion volume techniques negate the need for cuff pressure monitoring Signup and view all the answers

What does a sharp rise in exhaled CO2 at the beginning of exhalation on a capnographic tracing indicate?

Alveolar gas that has participated in gas exchange Signup and view all the answers

What might account for a sudden decrease in end-tidal CO2?

The ventilator circuit has become disconnected Signup and view all the answers

What is the likely cause of mild stridor immediately after extubation?

Upper airway obstruction Signup and view all the answers

What is the primary reason for the use of respiratory care protocols?

Standardize provision of care Signup and view all the answers

What is normal urine output in an adult patient?

40 mL/hr Signup and view all the answers

What device should be used for a patient with a cuffed tracheostomy tube for decannulation while maintaining stoma patency?

Tracheostomy button Signup and view all the answers

Which test should be recommended for a patient with chronic bronchitis and persistent infiltrates on chest X-ray?

Flexible bronchoscopy Signup and view all the answers

What best describes a patient with congestive heart failure receiving NPPV?

Hyperoxygenation Signup and view all the answers

Which physiologic value is consistent with proper fluid balance?

CVP between 3 and 6 mm Hg Signup and view all the answers

What should the respiratory therapist anticipate when assisting with a bronchoscopy on a ventilated patient?

The patient's extrinsic PEEP levels will increase Signup and view all the answers

In which patient condition is dynamic hyperinflation a major concern?

Chronic bronchitis Signup and view all the answers

What recommendations should be made for a postoperative patient struggling to cough effectively?

Applying pressure to the abdomen during exhalation Signup and view all the answers

What should be done for a 65-year-old female with advanced emphysema on a nasal cannula when she becomes drowsy?

Change to a 24% Venti-mask and repeat ABG Signup and view all the answers

What does a prothrombin time (PT) of 20 seconds indicate for a patient on warfarin (Coumadin)?

High likelihood of excessive bleeding Signup and view all the answers

What is the most likely condition for a mechanically ventilated patient with a sudden decrease in tidal volume?

Partial obstruction of the tracheostomy tube Signup and view all the answers

What is the purpose of incentive spirometry for a postoperative abdominal surgery patient?

Prevent areas of lung collapse Signup and view all the answers

A 48 year-old female is admitted to the ED with diaphoresis, jugular venous distension, and 3+ pitting edema in the ankles. These findings are consistent with:

Heart failure Signup and view all the answers

What action should the therapist recommend first for a patient with absent breath sounds in the left chest and trachea shifted to the right?

Needle aspirate the 2nd left intercostal space Signup and view all the answers

All of the following strategies are likely to decrease the likelihood of damage to the tracheal mucosa EXCEPT:

Monitoring intracuff pressures Signup and view all the answers

After completion of postural drainage, a 52 year-old patient’s breath sounds become more coarse. What should the therapist recommend?

Deep breathing and coughing to clear secretions Signup and view all the answers

What would be the most appropriate bronchial hygiene therapy for a 65 kg spinal cord injured patient with an inspiratory capacity of 30% of his predicted value?

IPPB with normal saline Signup and view all the answers

What is the most appropriate therapy for a dyspneic patient with crepitus and absent breath sounds on the right?

Insert a chest tube Signup and view all the answers

Calculate the patient's C(a-v)O2 given the following ABG results: pH 7.50, PaCO2 30 torr, PaO2 62 torr, HCO3 25 mEq/L, SaO2 92%, HB 14 g/dL, BE +2.

5.0 vol% Signup and view all the answers

What is the patient's static lung compliance based on the following parameters: A patient on VC, SIMV with a VT of 500 mL, PIP of 25 cm H2O, Pplat of 15 cm H2O and PEEP of 5 cm H2O?

50 mL/cm H2O Signup and view all the answers

Immediately after extubation, a patient shows increasing respiratory distress with intercostal retractions and marked stridor. What is the most appropriate action at this time?

Reintubation Signup and view all the answers

Which of the following patients would most likely benefit from pressure support ventilation?

A patient on SIMV with a set rate of 12/min and a total rate of 24/min Signup and view all the answers

Which initial recommendation should be made for a patient on mechanical ventilation who developed a fever and increased peak inspiratory pressure?

Obtain a sputum gram stain Signup and view all the answers

Why is it important for a patient on aerosol therapy to follow recommended cleaning procedures using a vinegar/water solution?

Retard bacterial growth Signup and view all the answers

What condition should a respiratory therapist suspect in a patient with a dry, non-productive cough, decreased tactile fremitus, and dullness to percussion over the right lower lobe?

Pleural effusion Signup and view all the answers

What size suction catheter is appropriate for a patient with an 8.0 mm ID endotracheal tube?

12 Fr Signup and view all the answers

What is the most likely explanation for diminished breath sounds and trachea shifted to the left in a patient receiving continuous mechanical ventilation?

The endotracheal tube has slipped into the right main stem bronchus Signup and view all the answers

What should be the immediate response to a developing hematoma after arterial blood gas drawing?

Apply pressure to the site Signup and view all the answers

What condition is most likely to cause a respiratory pattern that irregularly increases and decreases with periods of apnea?

Elevated intracranial pressure Signup and view all the answers

What value for the apnea-hypopnea index (AHI) indicates mild obstructive sleep apnea?

5 to 15 Signup and view all the answers

If PtcO2 increases from 60 to 142 torr and PtcCO2 changes from 37 to 2 torr, what is the most likely explanation for these changes?

Air leak around the sensor Signup and view all the answers

A patient on a 28% air entrainment mask with the flowmeter set at 5 L/min. What is the total flow delivered to the patient?

55 L/min Signup and view all the answers

Which measurement is most indicative of pulmonary edema?

Pulmonary capillary wedge pressure of 30 mm Hg Signup and view all the answers

What is sleep apnea defined as?

10 seconds or longer Signup and view all the answers

Which of the following conditions could potentially cause increased peak inspiratory pressure following a bronchoscopy?

Hypoxemia Signup and view all the answers

What size endotracheal tube is appropriate for an adult female patient?

7.0 to 7.5 mm Signup and view all the answers

How should the therapist measure Auto-PEEP on a patient receiving mechanical ventilation?

Initiate an expiratory hold just prior to the next ventilator-delivered breath Signup and view all the answers

What is the primary advantage of volume-controlled ventilation compared to pressure-controlled ventilation?

VC provides a constant minute ventilation Signup and view all the answers

What does bronchial breath sounds heard over lung periphery indicate?

Lung consolidation Signup and view all the answers

How should the respiratory therapist interpret bedside spirometry results showing FVC 88% of predicted, FEV1 85% of predicted, FEV1/FVC 82% of predicted, and FEF25-75 81% of predicted?

Normal lung function Signup and view all the answers

What action should the respiratory therapist take for a 55 year-old male during a cardiopulmonary stress procedure who suddenly complains of chest pain and shortness of breath?

Terminate the procedure immediately Signup and view all the answers

Based on the APGAR scores assigned at 1 minute and 5 minutes post-delivery, what should the scores be?

6 & 10 Signup and view all the answers

How much volume of albuterol should be administered to a patient via small volume nebulizer if 2.5 mg is the required dosage with a 0.5% solution?

0.50 mL Signup and view all the answers

What should the respiratory therapist do after a pulmonologist documents a change in a patient's treatment regimen?

Check the electronic medical record for new physician orders Signup and view all the answers

A 60 kg patient mechanically ventilated has peak airway pressure of 60 cm H2O. What is the most appropriate action to reduce this pressure?

Change to airway pressure release ventilation Signup and view all the answers

To verify the accuracy of a lab-based spirometer device, what should the respiratory therapist utilize?

3.0 L syringe Signup and view all the answers

What should be done FIRST to assess a patient brought to the ED after an overdose with sonorous respiratory efforts?

Obtain an ABG Signup and view all the answers

A 60 year-old male admitted with chest pain has a troponin level of 0.4 ng/mL. What should the physician report to this patient?

Myocardial infarction Signup and view all the answers

For a young healthy adult complaining of intermittent wheezing and having a normal bronchodilator spirometry result, what should the respiratory therapist recommend?

Bronchial provocation Signup and view all the answers

Twenty-four hours after being intubated, a patient develops a fever and infiltrate. What should the respiratory therapist recommend?

Antibiotic therapy Signup and view all the answers

What amount of air should be injected into the cuff of a newly inserted tracheostomy tube?

Enough to achieve a pressure of 25-35 cmH2O Signup and view all the answers

Which condition can NOT be treated with hyperbaric oxygen (HBO) therapy?

Pulmonary hypertension Signup and view all the answers

What factors determine cardiac output?

Stroke volume and heart rate Signup and view all the answers

Given the following ABG results for a patient in the ED: pH 7.20; PaCO2 24 torr; PaO2 95 torr; HCO3 8 mEq/L; SaO2 95%; BE -15 mEq/L, what should the therapist recommend?

Administering sodium bicarbonate intravenously Signup and view all the answers

What inspiratory flow pattern will help deliver the lowest peak inspiratory pressure?

Decelerating Signup and view all the answers

Study Notes

Heart Failure and Its Indicators

Key indicators of heart failure include diaphoresis, jugular venous distension, and pitting edema in the ankles.
Patients with heart failure often present with respiratory distress and fatigue.

Emergency Responses in Trauma Cases

Absent breath sounds and trachea deviation in trauma patients may indicate tension pneumothorax; immediate needle decompression is crucial.
Hyperresonant percussion notes coupled with vital sign changes require rapid intervention.

Tracheal Mucosa Protection Strategies

Maintaining cuff pressures between 20 and 25 mm Hg, using the minimal leak technique, and monitoring pressures are essential.
Incorrect monitoring of intracuff pressures may lead to mucosal damage.

Management of Post-Operative Complications

Coarse breath sounds post-cholecystectomy indicate the need for deep breathing exercises to clear secretions.

Bronchial Hygiene Therapy for Atelectasis

Initial bronchial hygiene for spinal cord injury patients with atelectasis should involve intermittent positive pressure breathing (IPPB) with saline.

Understanding Auto-PEEP and Ventilation Adjustments

Tidal volume, respiratory rate, and inspiratory flow can be adjusted to increase expiratory time and manage auto-PEEP in ventilated patients.

Chest Tube Insertion Protocols

Conditions such as absent breath sounds, tracheal deviation, and crepitus necessitate the immediate insertion of a chest tube for stabilization.

Arterial Blood Gas Interpretation

A calculated C(a-v)O2 of 5.0 vol% may indicate inadequate oxygen delivery despite normal parameters.

Lung Compliance and Ventilation Parameters

Static lung compliance can be calculated using inspiratory pressures and volumes; normal values are important for assessing respiratory mechanics.

Respiratory Distress Post-Extubation

Increasing respiratory distress and stridor following extubation indicates the need for reintubation as a priority intervention.

Benefits of Pressure Support Ventilation

Patients on SIMV with a high total respiratory rate may benefit from pressure support ventilation to ease work of breathing.

Infection Control in Mechanical Ventilation

Increased inspiratory pressure and fever in ventilated patients may necessitate sputum analysis to identify potential infections.

Pulmonary Function Testing Essentials

Forced vital capacity (FVC) maneuvers help determine FEV1 and peak expiratory flow rate but do not provide total lung capacity.

Aerosol Therapy Best Practices

Proper cleaning of nebulizers with a vinegar solution is vital to prevent bacterial growth and ensure patient safety.

Diagnostic Indicators of Pleural Effusion

Symptoms like diminished breath sounds, dull percussion, and decreased tactile fremitus suggest pleural effusion as a likely diagnosis.

Suction Catheter Sizing

For an 8.0 mm ID endotracheal tube, a 12 Fr catheter is appropriate for effective suctioning without causing trauma.

Complications in Ventilated Patients

Diminished breath sounds and dullness may indicate endotracheal tube displacement to a wrong bronchus or possible pneumothorax.

Hematoma Management Post-ABG Collection

Immediate application of pressure to an arterial puncture site is essential for managing hematomas following blood gas sampling.

ABG Analysis and Metabolic Conditions

A pH of 7.20 with low HCO3 indicates a metabolic acidosis likely requiring intervention such as sodium bicarbonate administration.

Ventilation Techniques and Patient Synchrony

Volume-controlled ventilation is favored for maintaining consistent minute ventilation, while decelerating flow patterns benefit peak pressures.

Pediatric APGAR Scoring

APGAR scores reflect a newborn's initial condition and recovery; scoring at 1 minute and 5 minutes should be charted accurately.

Nebulizer Dosage Calculations

Correct volume administration for nebulized medications is critical; 2.5 mg of albuterol from a 0.5% solution requires 0.50 mL.

Follow-up on Physician's Orders

Checking electronic medical records for pending treatment changes is essential in the clinical setting to ensure patient care continuity.

Understanding APGAR and Resuscitation Needs

Monitoring newborns post-delivery includes assessing heart rate, color, and reflexes to ensure they achieve stable APGAR scores.

Equipment Maintenance in Home Care

Instructions for patients experiencing equipment malfunction should include switching to reliable alternative delivery methods if issues arise.

Managing Large Secretions and Nasotracheal Suctioning

Continuous suctioning causing complications such as epistaxis necessitates a reassessment of suction needs and potential airway interventions.### Airway Management
Insert a nasopharyngeal airway after controlling bleeding.

Diagnosis of Conditions

Air bronchograms and increased density on a chest X-ray most likely indicate pneumonia.
A patient exhibiting medium crackles throughout both lungs may require regular coughing and deep breathing for management.
The least compatible finding with hyperlucency on a chest X-ray is increased fremitus.

Respiratory Therapy Recommendations

For a post-operative patient on mechanical ventilation with stable vital signs, increase FIO2 if PvO2 is low.
In the context of an intubated patient undergoing a spontaneous breathing trial, extubation is appropriate when vital signs remain stable after 30 minutes.
If a patient experiences increased peak inspiratory pressure after bronchoalveolar lavage, possible causes may include bronchospasm, pneumothorax, or pulmonary hemorrhage.

Infection Control in Healthcare

Poor handwashing techniques by personnel are the primary source of infection in healthcare settings.

Monitoring and Interventions

A blood gas sample should be placed in an ice bath after collection for proper handling.
For patients receiving mechanical ventilation, assess changes in lung function and adjust pressures as needed; increase the mandatory rate to address hypoventilation.

Urine Output and Patient Monitoring

Normal urine output for adults is approximately 40 mL/hr, indicating proper kidney function.
Monitor for complications related to airway suctioning; hypoxemia is the most serious risk.

Patient Positions and Procedures

The appropriate postural drainage position for a patient with infiltrates is head down, prone with a pillow under the hips.
Methodologies like lung expansion therapy should be employed for patients post-surgery with radiographic infiltrates.

Specialty Treatments and Techniques

To facilitate tracheostomy decannulation while maintaining stoma patency, use a tracheostomy button.
For significant alveolar hypoventilation, an arterial carbon dioxide tension around 50 torr is indicative.

Emergency Situations

In cases of suspected left tension pneumothorax, symptoms will include tachypnea and deviated trachea based on physical assessment.
For sudden decreases in end-tidal CO2 in mechanically ventilated patients, check for ventilator disconnections as a possible cause.

Medication and Treatment Precautions

Elevate FIO2 or change delivery methods (like switching to a Venti-mask) if a patient with COPD deteriorates on low-flow oxygen.
When administering albuterol, if tachycardia is noted, reduce the dose for subsequent treatments.
Rocuronium or succinylcholine are recommended neuromuscular blockers for rapid intubation due to their fast onset.

Patient Education

Incentive spirometry aims to prevent lung collapse, especially following surgery, and should be explained to patients accordingly.

Technical Considerations

For bronchoscopy preparations, ensure proper monitoring of tidal volume and awareness of resistance changes.
Disinfect pulse oximeter surfaces between patients with 70% ethyl alcohol for infection control.

Pediatric Monitoring

The Silverman score assesses the severity of respiratory distress in newborns, important in pediatric care.

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Description

Explore the critical aspects of carbon monoxide poisoning, its symptoms, and management strategies. This quiz delves into the definitions and clinical features to enhance your understanding of this medical emergency.