Richmond Agitation-Sedation Scale (RASS) Quiz

CPAP and BiPAP.

BiPAP provides higher pressure during inspiration (IPAP) and lower pressure during expiration (EPAP).

Decreased level of consciousness, hemodynamic instability, and facial trauma.

<p>NPPV can reduce intubation rates by 65%, shorten hospital stays, and improve mortality.</p> Signup and view all the answers

<p>Glasgow Coma Scale score less than 11, sustained arterial pH less than 7.25, and tachypnea greater than 35 breaths/minute.</p> Signup and view all the answers

<p>HFNC may improve outcomes in acute hypoxemic respiratory failure and demonstrate favorable results post-extubation.</p> Signup and view all the answers

<p>Ongoing management involves regular adjustments of ventilator settings to ensure proper gas exchange and tidal volume delivery.</p> Signup and view all the answers

<p>A RASS score of +4 indicates that the patient is combative and poses an immediate danger to staff.</p> Signup and view all the answers

<p>A patient with a RASS score of -1 is drowsy, meaning they are not fully alert but can sustain awakening.</p> Signup and view all the answers

<p>A patient with a RASS score of +2 exhibits frequent nonpurposeful movements and may fight the ventilator.</p> Signup and view all the answers

<p>A RASS score of 0 signifies that the patient is calm, alert, and not experiencing any agitation.</p> Signup and view all the answers

<p>A patient with a +3 score is very agitated, pulling or removing tubes and demonstrating aggressive behavior.</p> Signup and view all the answers

<p>A RASS score of +1 indicates that the patient is restless and anxious, but their movements are not aggressive or vigorous.</p> Signup and view all the answers

<p>The RASS scale can be utilized to assess and monitor a patient's sedation status, guiding medication adjustments.</p> Signup and view all the answers

<p>A low RASS score indicates reduced alertness and may necessitate close monitoring to prevent the risk of airway complications.</p> Signup and view all the answers

<p>Complications can include airway trauma, infection, and prolonged mechanical ventilation.</p> Signup and view all the answers

<p>NPPV is suitable for patients with rapidly reversible conditions or those with 'do-not-intubate' directives.</p> Signup and view all the answers

<p>Decreased level of consciousness and hemodynamic instability.</p> Signup and view all the answers

<p>Because emergent intubation may require immediate airway access, reducing the practicality of NPPV.</p> Signup and view all the answers

<p>Frequent reassessment of the patient's progress is essential.</p> Signup and view all the answers

<p>NPPV may improve preoxygenation compared to standard oxygen delivery methods.</p> Signup and view all the answers

<p>Facial trauma is a condition that can prevent an adequate mask seal.</p> Signup and view all the answers

<p>Neuromuscular blocking agents (NMBAs) are associated with such complications.</p> Signup and view all the answers

<p>Increased secretions can be a relative contraindication to using NPPV.</p> Signup and view all the answers

<p>Hemodynamic instability is a relative contraindication, as it may compromise ventilation during treatment.</p> Signup and view all the answers

<p>Pulse oximetry, end-tidal carbon dioxide (ETCO₂) measurement, ventilation pressures, and blood gas levels.</p> Signup and view all the answers

<p>Decreased lung compliance results in increased airway pressure during volume-controlled ventilation and reduced tidal volume in pressure-controlled ventilation.</p> Signup and view all the answers

<p>The typical initial Fio₂ setting for high-flow nasal cannula therapy is 50%.</p> Signup and view all the answers

<p>Plateau pressure measures maximal alveolar pressure at the end of inspiration and is unaffected by airway resistance.</p> Signup and view all the answers

<p>To determine pH and the adequacy of gas exchange.</p> Signup and view all the answers

<p>PCO₂ can be adjusted by modifying minute ventilation, which is the product of tidal volume and respiratory rate.</p> Signup and view all the answers

<p>Increasing flow rates can help alleviate hypoxemia and dyspnea, enhancing patient comfort.</p> Signup and view all the answers

<p>A tidal volume of 6 to 8 mL/kg of ideal body weight, a rate of 12 to 14 breaths/min, and an Fio₂ of 1.0 titrated to maintain oxygen saturation of 88-94% are recommended.</p> Signup and view all the answers

<p>Hyperoxemia (&gt;120 mm Hg) has been linked to increased mortality.</p> Signup and view all the answers

<p>Continuous capnography can reduce the need for blood gas monitoring.</p> Signup and view all the answers

<p>Fatigue is a key factor in selecting patients for NPPV.</p> Signup and view all the answers

<p>NPPV decreases the need for intubation by 65% in COPD exacerbations.</p> Signup and view all the answers

<p>The NNT with NPPV to improve mortality in COPD patients is 12.</p> Signup and view all the answers

<p>Treatment failure in NPPV is defined by subsequent intubation necessity and factors like a Glasgow Coma Scale score less than 11.</p> Signup and view all the answers

<p>The presence of pneumonia is an independent risk factor for NPPV failure.</p> Signup and view all the answers

<p>A sustained arterial pH &lt; 7.25 indicates a higher likelihood of treatment failure with NPPV.</p> Signup and view all the answers

<p>The trial found a mortality benefit favoring HFNC but no difference in intubation rates at Day 28.</p> Signup and view all the answers

<p>Longer duration of NPPV before intubation is associated with higher in-hospital mortality.</p> Signup and view all the answers

<p>Evidence for NPPV effectiveness in asthma and pneumonia patients is limited.</p> Signup and view all the answers

<p>The initial consideration is whether to use CPAP or Bi-level PAP based on the patient's needs.</p> Signup and view all the answers

Overly combative, violent, and a danger to staff.

Pulls or removes tubes/catheters and is aggressive.

Frequent, nonpurposeful movements, fights ventilator.

Anxious but movements are not aggressive or vigorous.

Patient is calm and alert.

Not fully alert but awakens briefly to stimulation.

Opens eyes to voice for a short time.

No response to voice, but opens eyes to painful stimuli.

A measure of the maximum pressure reached during a breath cycle, reflecting the total resistance of the respiratory system.

The pressure in the alveoli at the end of inspiration, after airflow has stopped. It's a better indicator of lung compliance compared to PIP.

A device that delivers a high flow of humidified oxygen and air mixture, typically used for patients with acute hypoxemic respiratory failure.

A type of mechanical ventilation where the ventilator delivers a set volume of air with each breath.

A type of mechanical ventilation where the ventilator delivers a set pressure with each breath.

The amount of air a patient breathes in with each inhalation.

The frequency of breaths per minute.

Fraction of Inspired Oxygen, a measure of the oxygen concentration delivered to the patient.

The amount of air moved in and out of the lungs per minute.

Positive End-Expiratory Pressure, a pressure maintained in the lungs at the end of exhalation to prevent alveolar collapse.

A type of ventilation that helps patients breathe without needing a breathing tube inserted into their windpipe (intubation).

A medical procedure where a tube is inserted into a patient's airway to help them breathe.

The decision to intubate a patient should be made carefully, considering the risks and benefits of both invasive and non-invasive methods.

NPPV may be a suitable option for patients with rapidly reversible conditions or those who have indicated they don't want to be intubated.

A person who is less conscious, lacks the urge to breathe, has excessive secretions, is unstable or has facial trauma may not be suitable for NPPV.

Even though intubation should typically be avoided before starting NPPV, it may be helpful to pre-oxygenate patients before intubating them.

Regularly checking on the patient's progress is crucial when they are using NPPV to ensure it is effective.

Drugs used to relax muscles and improve the effectiveness of ventilation.

Potential downsides of intubation include complications related to the breathing tube, medications to relax the muscles, and needing long-term mechanical ventilation.

A unit in a hospital that provides specialized care for critically ill patients.

A type of noninvasive ventilation that provides constant positive pressure throughout the respiratory cycle.

A type of noninvasive ventilation that alternates between higher pressure during inspiration and lower pressure during expiration.

A measure of how well a patient responds to stimulation, ranging from +4 (very agitated) to -4 (unarousable).

Used to predict the success of Noninvasive Positive Pressure Ventilation (NPPV).

The amount of air left in the lungs after a normal exhale.

The positive pressure that is maintained in the lungs at the end of exhalation.

This refers to patients who are most likely to show improvement with NPPV, often those with conditions that can be reversed.

A measure of how likely a treatment is to benefit a patient, calculated as the number of patients who need to be treated to see one positive outcome.

This refers to using NPPV for patients experiencing a worsening of their chronic obstructive pulmonary disease (COPD).

This happens when the heart is not pumping effectively, leading to fluid buildup in the lungs. NPPV aims to reduce the workload on the heart and improve breathing.

A primary concern with NPPV is whether it will be successful in improving breathing and preventing the need for invasive ventilation.

Inflammation of the lungs, which can make NPPV less effective and increase the risk of complications.

Using NPPV for too long without seeing improvement may be a sign that invasive ventilation is needed.

This involves adjusting the pressure settings and mask type based on the patient's needs and comfort level.