Clinical Simulation Flashcards: RRT Decision Making

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Questions and Answers

What is the oxygen saturation measurement represented by SpO2?

4,5,6 (correct)

7,8,9 (correct)

100

What is the recommended initial treatment for mild hypoxemia (PaO2: 75)?

2L Nasal cannula, recheck SpO2

What is the common treatment for atelectasis?

Incentive spirometry

What does SOB stand for?

Shortness of breath Signup and view all the answers

What medications are associated with CHF?

Digitalis, diuretics Signup and view all the answers

What should be initiated for impending hypercapnic respiratory failure?

NPPV Signup and view all the answers

What values indicate Acute Hypercapnic Respiratory Failure?

pH: 7.30, PaCO2: >50 Signup and view all the answers

What should be avoided in COPD patients?

High FiO2 Signup and view all the answers

What does 'marked' indicate in clinical terms?

Severe/emergency condition requiring immediate response Signup and view all the answers

What indicates an acute myocardial infarction (MI)?

Significant Q wave, elevated ST segment Signup and view all the answers

What is the treatment for ventricular tachycardia?

Defibrillation Signup and view all the answers

The steps for defibrillation include CPR until __________.

available Signup and view all the answers

What can cause progressive cyanosis and asymmetrical chest movement?

Right mainstem intubation Signup and view all the answers

What should be evaluated during the rapid evaluation of newborns?

Tone, breathing/crying, gestational age Signup and view all the answers

What is the Golden Minute in newborn care?

The initial minute after birth Signup and view all the answers

When a neonate's HR is less than 100 bpm, what should be initiated?

PPV Signup and view all the answers

What is the resuscitation approach for a neonate with HR < 60?

Begin resuscitation (3:1 ratio of chest compressions to ventilations) Signup and view all the answers

In case of a drug overdose, what is a priority?

Intubation Signup and view all the answers

What does the P/F ratio indicate?

80% pred. Moderate: FEV1 60-80%, Severe: FEV1 < 60% Signup and view all the answers

How is asthma impairment categorized?

Intermittent, Mild Persistent, Moderate Persistent, Severe Persistent Signup and view all the answers

What is the long term control medication for asthma?

Inhaled corticosteroids (fluticasone/salmeterol MDI) Signup and view all the answers

What should be monitored if a neuromuscular problem is suspected?

MIP, FVC, and initiate incentive spirometry Signup and view all the answers

When should a patient be intubated with neuromuscular disorders?

When VC falls below 1.0 L with marked hypoxemia Signup and view all the answers

How can overventilation be corrected?

Lower rate or lower tidal volume Signup and view all the answers

What is defined as severe hypoxemia?

PaO2 < 40 mmHg Signup and view all the answers

What is the first priority with any apparent heart problem?

Supplemental oxygen Signup and view all the answers

What are the key points of CHF?

Cardiomegaly, diffuse infiltrates, pedal edema Signup and view all the answers

What therapy is indicated for suspected MI?

Anticoagulant therapy Signup and view all the answers

What should be done after a recent MI?

Use ultrasound to identify the cause of CHF Signup and view all the answers

What is crucial in immediate emergency care?

Placement of airway and 100% O2 Signup and view all the answers

What is the treatment for severe metabolic acidosis?

Administer sodium bicarbonate Signup and view all the answers

What should be done if there is a high-pressure alarm?

Suction patient Signup and view all the answers

What is indicated by increasing chest pain?

Obtain a chest X-ray Signup and view all the answers

Which procedure is performed for pleural effusion?

Thoracentesis Signup and view all the answers

What is the priority treatment for Epiglottitis?

Intubation Signup and view all the answers

What should be done for DM Epiglottitis?

Sedation and wrist restraints if thrashing, ABX, monitor pulse ox, ventilatory support Signup and view all the answers

What is used to diagnose Epiglottitis?

Thumb sign on lateral neck X-ray Signup and view all the answers

What are the key indicators of croup?

Loud, barking cough, steeple sign Signup and view all the answers

What tests are used for cystic fibrosis diagnosis?

Sweat chloride test, CXR Signup and view all the answers

What are the medications used for CF?

CTFR (ivacaftor), nebulized Tobramycin, Pulmozyme Signup and view all the answers

What should be done for ventilation/oxygenation in patients?

Draw ABG on room air if able, follow with 2L nasal cannula Signup and view all the answers

What is the treatment for status asthmaticus?

Administration of corticosteroids (Solu-Medrol) and aggressive bronchodilators (Albuterol) Signup and view all the answers

What is the treatment for newborn hypoxemia?

Nasal CPAP, use lowest FiO2 to achieve SpO2 > 90% Signup and view all the answers

What is the treatment for RDS in a newborn?

Surfactant replacement therapy Signup and view all the answers

What are the initial vent settings for a newborn?

PC/IMV settings: PIP: 20-25 cmH2O, RR: 30-40 bpm, PEEP: 4-7 cmH2O, IT: .4, Flowrate: 8-12 Signup and view all the answers

How is general decision making often summarized?

'Next' = FIRST Signup and view all the answers

What is the primary treatment for pneumonia?

Administer antibiotics (Ciprofloxacin) Signup and view all the answers

What symptoms are associated with pleural effusion?

Chest pain on one side, absent breath sounds, blunting of costophrenic angle Signup and view all the answers

What can pleural fluid analysis indicate?

Exudative: local disease; Transudative: systemic illness Signup and view all the answers

What is the priority during a pediatric asthma exacerbation?

Bronchodilation Signup and view all the answers

What treatments are involved in bronchiectasis?

O2 to reverse hypoxemia, dyspnea, and tachypnea, antibiotics Signup and view all the answers

How is bronchiectasis diagnosed?

CT scan (increased airway diameters), sputum gram stain, CXR Signup and view all the answers

What does AIDS decision making involve?

Monitoring with continuous pulse oximetry, ECG, ABGs Signup and view all the answers

What monitoring is recommended for COPD?

Spirometry (FEV1) after bronchodilator Signup and view all the answers

What is the GOLD standard for COPD?

Mild: FEV1 > 80% predicted; Moderate: FEV1 > 50-70% Signup and view all the answers

Study Notes

SpO2 and PaO2

SpO2 and PaO2 are critical indicators of oxygenation status in patients.

Mild Hypoxemia

Mild hypoxemia (PaO2: 75) requires the use of a 2L nasal cannula and subsequent SpO2 recheck.

Atelectasis

Incentive spirometry can help manage and prevent atelectasis.

Shortness of Breath (SOB)

Bronchodilator treatments are indicated for patients presenting with SOB.

Congestive Heart Failure (CHF)

Treatment options for CHF include digitalis and diuretics.

Impending Hypercapnic Respiratory Failure

Initiate non-invasive positive pressure ventilation (NPPV) for impending hypercapnic respiratory failure.

Acute Hypercapnic Respiratory Failure

Defined by pH: 7.30 and PaCO2: >50; intubation and initiation of mechanical ventilation (MV) are necessary.

Chronic Obstructive Pulmonary Disease (COPD)

High fractional inspired oxygen (FiO2) levels should be avoided in COPD management.

Marked Conditions

A "marked" condition indicates a severe emergency that necessitates immediate and maximum response, often requiring 100% FiO2.

Acute Myocardial Infarction (MI)

Significant Q waves and elevated ST segments on an ECG indicate an acute myocardial infarction.

Ventricular Tachycardia

Treatment protocol for ventricular tachycardia includes immediate defibrillation.

Defibrillation Steps

Perform CPR until ready, activate the defibrillator, select 200 joules, disable synchronizer, and apply pads to the chest.

Right Mainstem Intubation

Symptoms include progressive cyanosis and asymmetrical chest movement.

Newborn Assessment

Rapid evaluation involves assessing tonicity, breathing, and gestational age.

The Golden Minute

The first minute post-birth is critical; if no improvement, commence positive pressure ventilation (PPV).

Neonate Heart Rate Interventions

HR < 100 bpm in neonates prompts initiation of PPV.

Bag-Valve-Mask Resuscitation

Indicated for neonates < 35 weeks gestation, with specific respiratory parameters.

Neonatal Resuscitation

For HR < 60, initiate resuscitation using a 3:1 ratio of chest compressions to ventilations.

Drug Overdose Protocol

In cases of drug overdose, prioritize intubation and initiate mechanical ventilation if respiratory failure is present.

P/F Ratio

Hypoxia severity defined by P/F ratio: moderate at FEV1 60-80% and severe at FEV1 < 60%.

Asthma Impairment Levels

Asthma symptoms categorized as intermittent, mild persistent, moderate persistent, and severe persistent based on frequency.

Long-Term Asthma Management

Inhaled corticosteroids, such as fluticasone/salmeterol MDI, are essential for long-term asthma control.

Neuromuscular Problems

Monitor maximal inspiratory pressure (MIP) and forced vital capacity (FVC); start incentive spirometry if neuromuscular issues are suspected.

Intubation Criteria for NM Disorders

Intubation is warranted when vital capacity falls below 1.0 L and marked hypoxemia is present.

Overventilation Correction

To correct overventilation, reduce the rate or tidal volume.

Severe Hypoxemia

Defined as PaO2 < 40 mmHg; requires immediate intervention.

Heart Conditions

For any suspected heart problems, the first step is supplemental oxygen (NRB for severe hypoxemia).

Key CHF Indicators

Look for cardiomegaly, diffuse infiltrates, and pedal edema in CHF cases.

MI Treatment

Anticoagulant therapy is critical when MI is suspected.

CHF Diagnostics

For recent MI, use ultrasound to identify underlying causes of CHF.

Emergency Care Essentials

Immediate airway placement and administration of 100% O2 are fundamental in emergencies.

Severe Metabolic Acidosis Treatment

Sodium bicarbonate administration is indicated for severe metabolic acidosis.

High-Pressure Alarm Response

Address high-pressure alarms by suctioning the patient.

Chest Pain Evaluation

If experiencing increasing chest pain, obtain a chest X-ray (CXR) for evaluation.

Pleural Effusion Management

Presence of unilateral chest pain and absent breath sounds on one side indicates pleural effusion; thoracentesis is the treatment.

Pleural Fluid Analysis

Exudative fluid indicates local disease (e.g., malignancy), while transudative fluid suggests systemic illnesses (e.g., liver cirrhosis).

Pediatric Asthma Exacerbation

Bronchodilation is the top priority in pediatric asthma exacerbations.

Bronchiectasis Treatment

Treat with oxygen to reverse hypoxemia and antibiotics for infection.

Diagnosing Bronchiectasis

Diagnosis confirmed via CT scan (increased airway diameters), sputum gram stain, and chest X-ray (CXR).

AIDS Management

Continuous monitoring of pulse oximetry, ECG, and ABGs; include bronchodilators and ARV medications in treatment.

COPD Monitoring

Spirometry, particularly FEV1, is essential after bronchodilator treatment for COPD patients.

GOLD Standard for COPD

Classification based on FEV1 percentages: mild (FEV1 > 80% predicted), moderate (FEV1 50-80% predicted).

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This quiz consists of flashcards focusing on crucial terms related to respiratory therapy decision-making in clinical simulations. Each card presents a key concept along with its definition, helping students reinforce their understanding of essential clinical knowledge and interventions.