Download ACCS Lindsay Jones Questions and 100 % answers 2025 and more Exams Biomedicine in PDF only on Docsity!
ACCS Lindsay Jones Questions and answers with
100% correct solutions | A+ Grade 2025
Mucomyst ✔✔Aka Acetylcystine Give w/bronchodilator to prevent bronchoconstriction Strength: 10% and 20 % Dosage: 2 to 4.0 ml Morphine ✔✔used to treat anxiety and pain is the choice for ACCS test careful giving to COPD cause of respiratory drive Propofol ✔✔Aka diprivan used for quick sedation and anesthesia in high doses has very short half life good for getting pt of sedation quick. Dornase Alpha ✔✔Used to thin secretions of COPD and CF patients What is the starting dose for Nitric Oxide? ✔✔ 2 to 4 ppm start 20 or higher. Usually start 40ppm on exam and titrate down Usually given thru vent.
Why should Nitric Oxide be slowly stopped? ✔✔Just turning it off without allowing time to wean can cause rebound affects high pulmonary pressure. Sometimes even worse than before. Pa02 can decrease and PVR and mPAP will increase How do you wean from iNO therapy ✔✔reduce the level by 10ppm every 2hrs until you reach 10. Then reduce by 2.5 every 2hrs Uses for Nitric Oxide therapy ✔✔increased PVR like Pulmonary HTN Right heart failure patent foramen Ovale What does Nitric Oxide do? ✔✔Dilates the pulmonary vessels to reduce work on heart and decrease pulmonary blood pressure Heliox uses ✔✔Severe asthma ARDS COPD Upper airway obstruction Stridor Pulses Paradoxus Pulses Paradoxus ✔✔Airway resistance is so high that BP falls with inspiration Affects of heliox on COPD ✔✔helps keep FRC down and limit air trapping
- add remaining inches (in x6)+ ** if pt is over weight by 20lbs cont. by: taking (height /2) then take off 10% (move over one decimal) Patient is 5'11" 280 lbs. Is the patient obese? find amount in KG. solve for 6 - 8 mL/kg VT. ✔✔ex Patient = 5'11" 280 lbs 106+(6x11) =66+ =172 #pt is overweight. find amount in KG 172/2= 86 .... subtract 10% (move decimial over one) 86 - 8.6=77. VT= 6 to 8 ml/kg 6x77.4= 309 to 8x77.4= 619. What is the initial Rate on a vent ✔✔ 10 - 18 bpm What is the initial Fi02 on vent? ✔✔ 30 - 60% unless it is an emergency What is the initial Peep setting? ✔✔ 0 - 9cmh20 unless ARDS then 10cm or match the Epap What is the initial vent sensitivity setting? ✔✔-0.5 to - 0.
normally - 2. What is the ARDS criteria? (berlin definition) ✔✔Diffuse bilateral infiltrates P/F ratio < reticulogranular pattern on x-ray (ground glass) Very poor pulmonary compliance When do you use HFOV as an ARDS intervention? ✔✔can be used when Pplat and PIP is too high and pose risk for lung barotrauma What is the starting hertz for HFOV? ✔✔ 4 - 8 htz what does one hertz for HFOV equal? ✔✔ 1 htz=60 cycle breaths ex 4Htz*60(cycles)=240 bpm What is the amplitude and what is the initial setting? ✔✔amp or driving pressure = vt need enough to see the chest wall visibly vibrate What is HFOV initial I:time? Bias Flow? ✔✔I:time= 33% Bias Flow= 40 l/min What do you set the Fi02 and PEEP initially for HFOV? ✔✔same as vent 30 - 50% and 0 - 9cmh When do you change from VC to PC vent mode? ✔✔The lungs are acting stiff, PIP is >55mmhg.
What do you do if the CO2 is 30 or less ✔✔decrease the rate *do not go below 8 What is the initial Insp pressure setting for PC ventilation? ✔✔Insp Pressure 20cm or 4 - 6ml/kg What is the initial rate for PCV? ✔✔ 12 - 24 What is the initial Peep for PCV? Fi02? ✔✔PEEP is 10 or greater Fi02 is <60% When do you lower the PEEP to change the Pa02? When do you lower Fi02? ✔✔When Pa02 is >100 and Fi02 is <55% lower Fi02 if Pa02 is >100 and Fi02 is >60% What are the indications for APRV ✔✔ALI ARDS Extensive ATX Diffuse PNA Trans esophageal Fistula What is APRV basically? ✔✔APRV is reverse I:E.
How does APRV work ✔✔it allows for the patient to get max insp. by lengthening the I time allowing for more oxygenation and control of ATX and intermittently releasing PAP to allow for exhale of C02. **Patients lungs are usually less compliant meaning they need more time to inhale and stiff lungs will want to close meaning it takes less time to exhale. APRV initial vent settings ✔✔Phigh= set to Pplat or Paw+3 and <35cmH PLow= 0-3 cmH20 (lowest pressure) Thigh= 4.5 to 6.0 sec (highest exhale time) Tlow= 0.5 to 0. How do you wean from APRV? ✔✔Use drop and stretch method decrease Phigh by 1 - 2cm and Thigh by 0.5 sec. every 2 hrs to avoid Alv collapse when @Phigh 10cm switch to PAP 10cm w/PS 5- 10 Normal Cardiac output ✔✔ 4 to 8 L/min True or False You should continue using PEEP if the cardiac output is 6 L/min ✔✔true only stop if the CO is less than 4 Who is NIV the best for? ✔✔COPD- prevents intubation & difficult weaning Ventilation while waiting for drugs to take affect or wear off decrease WOB
What is the final effort to help intractable ARDS on pT with Fi02 1.0 and PEEP at max? ✔✔iNO therapy Epoprostenol ✔✔AKA Flolan. Similar to iNO. Can be nebulized. Photosensitive. Criteria for Weaning ✔✔-all vitals are stable
- ABGs in acceptable range *copd can have high CO2 if PH is Fully compensated
- Spont. Vt @ least 5ml/kg
- MIP > 20cmh
- VC at least 10 L/kg
- Shunt (QS/QT) 20% or less
- A-a(D02) 300 or less
- RSBI <
- underlying problem resolved (not apply to chronic issue) RSBI ✔✔= RR/VT (L) needs to be below 106 for weaning Weaning from SIMV ✔✔decrease rate by 2 every 20 - 60 min when Fi02 0.4, Rate 4, Peep 5 pt. can be removed from ventilation to Cpap or PS w/ ABG done 20-30 mins later. Spontaneous Breathing Trial ✔✔SBT last 1-6hrs pt is allowed to sport. (PS or CPAP) breathe while intubated while RR, VT, MIP, HR, BP AND SPO2 is monitored. Pt can work up to longer periods if needed ex: start at 3hrs after failing at 3.5 hrs.
How does diet affect vent weaning? ✔✔High calorie diet can harm weaning attempts. Due to burden of excess C02 clearance. Calories should be decreased for weaning and SBTs if pt is on high calorie diet. what does it mean if there is excessive bubbling in the water seal chamber of chest tube ✔✔The patient has likely perforated lung tissue esp. if there is low return vent alarm. There should always be some bubbling When should PS be used for weaning? ✔✔When Pt is in SIMV AND spont trial vt are below 5ml/kg. PS will help overcome resistance of airways What are the ways to prevent vent related lung injury? ✔✔-Avoid VT <4- 6 ml/kg
- avoid alveolar collapse by keeping PEEP at least 10cm
- avoid inflammatory disease caused by over distension
- minimize Paw and prevent o2 toxicity
- Keep Fi02 low ideally 0.4 or less
