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Covid-19 Lessons Learned (Presentations)
Pfizer-BioNTech Moderna are ___ in the US - correct answer approved in the US Johnson and Johnson Janssen are limited due to - correct answer life threatening blood clots most people who get covid are - correct answer unvaccinated fully vaccinated people who get covid are called - correct answer breakthrough infection **may develop symptoms but are less severe rapid point of care (POC) testing - correct answer results in 30 minutes; must have current infection laboratory tests can take days and is called - correct answer transcription polymers reaction (PCR) *the gold standard & nucleic acid application test (NAATs) negative results should be considered - correct answer presumptive and should be considered with PCR least protective mask - correct answer cloth filtered moderate protective mask - correct answer N safest mask - correct answer N95 (respirators) how to protect yourself from covid when you are over the age of 2 - correct answer wear a facemark, wash your hands for 20 seconds with soap and water, 6 feet social distancing medication for the treatment of mild to moderate COVID - correct answer paxlovid nirmatrelvir dosage - correct answer 2x 150mg tablet ritonavir dosage - correct answer 1100 mg tablet 2x for 5 days what medication should be used in hospitalized patients requiring supplemental oxygen or invasive mechanical ventilation; 24 hours after administering ICU - correct answer dexamethasone
aerosol-generating procedures is - correct answer a treatment or procedure that generates more aerosols than during coughing, sneezing, speaking, or normal breathing. generating bioaerosols containing micro-organisms carries the risk of contamination and transmission medical aerosols - correct answer the aerosols (10-30%) that are generated from medical devices like nebulizers fugitive aerosols - correct answer remaining aerosols that are released or echoed to the environment not all aerosols generated can cause - correct answer infection and contamination nebulization/SVN - correct answer aerosols concentration is increased, and the patient will inhale part of it and the rest will be fugitive aerosols. use expiratory filter in the exhalation portal with aerosol face mask, use scavenger or filter facemask intubation with spontaneous breathing patients - correct answer sedatives are used to suppress cough and reduce dispense or aerosol intubation boxes are not recommended PFT - correct answer filters are recommended to be attached to the mouthpiece or mask otherwise, contained aerosol particles will be all over the room or lab cardiopulmonary rehabilitation and cardiopulmonary exercise - correct answer wearing procedure masks is highly recommended, and educate the patients to cover their mouth with a tissue or mask reducing the risk of bioaerosols not aerosol generating procedure (APG) - what devices are not APG and can be safely used during COVID - correct answer HFNC, CPAP, NIV what is recommended for HFNC patients - correct answer wearing a procedure facemark over cannula HFNC doesn't generate bioaerosols beyond patient normal breathing, can't disperse around the room
compared to HFNC and conventional oxygen therapy, CPAP had - correct answer 34% of its group, within the Perkins study, undergo adverse events CPAP will be mainly effective in patients that have - correct answer COVID-19 tied with acute hypoxemic RF Bilevel ventilators can be deployed for - correct answer invasive ventilation when critical care ventilators are unavailable IPAP (ventilation focused) and EPAP (oxygenation focused) are setting that are used for bilevel ventilation. the difference between IPAP and EPAP is - correct answer the level of pressure support that the patient is receiving to assure precise FiO2 and deliver high Fio2, it is best to use - correct answer a bilevel ventilator with an integral oxygen blender hypoxemia-induced compensatory mechanisms: primary compensatory mechanisms increase - correct answer cardiac output and hyperventilation this occurs when PaO2 is less than or equal to 60mmHg hypoxemia-induced compensatory mechanisms: hypoxic ventilator response is dependent on - correct answer PaCo hypoxemia-induced compensatory mechanisms: a normal PaCo2 of 35-45 enhances the - correct answer ventilatory response to hypoxemia hypoxemia-induced compensatory mechanisms: normally paco2 is the stimulus for respiratory drive, when pao2 is below 45 mmhm it becomes - correct answer the primary stimulus respiratory drive hypoxemia-induced compensatory mechanisms: when pao2 is below 30, erratic breathing begins followed by - correct answer apnea and brain stem death hypoxemia and sudden clinical deterioration in COVID-19: people with diminished adrenergic response and cardiovascular reverse experience - correct answer worsening hypoxemia compared to healthy people hypoxemia and sudden clinical deterioration in COVID-19: these factors increase the likelihood of - correct answer metabolic acidosis, cardiovascular failure and ARDS
these factors will determine the use of NIV compared to intubation hypoxemia is a poor stimulus for - correct answer dyspnea compared to hypercapnia the four factors that explain the perception of silent hypoxemia in COVID- 19 - correct answer 1. compensatory mild hypocapnia
- normal work of breathing
- blunted respiratory drive response to both hypoxemia and hypercapnia in older adults and those with diabetes
- the negative bias in pulse oximeters as hypoxemia worsens evidence to support silent hypoxemia is - correct answer low quality It is a large prospective case-controlled study involving 470 subjects with a baselineSpO2 < 80%, 5% of hypoxemic subjects with SpO2 of 76% at room air, 91% were - correct answer tachypneic silent hypoxemia is not unique in - correct answer covid- 19 The first wave during the pandemic, the bulk of patients were older with diabetes as acomorbidity, which could have contributed to - correct answer a prevalence of silent hypoxemia It is important for us to prevent and treat aggressively if - correct answer hypoxemia does occur during COVID- 19 dark pigment has been known to - correct answer absorb more of the two wavelengths of light with aresulting report of SpO2 that is greater than SaO A darker patient may have an SpO2 of 92% but SaO2 of 86% what should be done in a darker patient to measure blood oxygenation directly - correct answer arterial blood gas symptoms regarding COVID could have - correct answer a genetic factor there is no distinction between the different types of - correct answer ARDS how should ARDS be treated - correct answer using the same treatment guidelines for all ARDs cover causes - correct answer severe hypoxemia
- pneumothorax.subcutaneous emphysema (0.2-5%)
- accidental tube dislodgment (3-4%)
- secretion obstruction (5%) recommendations for enhanced personal protection during tracheostomy - correct answer o Procedure done in a negative pressure room with personnel using a powered air-purifying(PAPR) device oA fit-tested filtering facepiece (FFP3) o Or an N95 along with face shield/eye goggles and an additional surgical mask, caps,boots, fluid- repellent disposable gown and double gloves The majority of studies found no COVID 19 reports among the surgical what are the 2 types of ECMO - correct answer 1. V-V-ECMO (venous extracorporeal membrane oxygenation)
- V-A-ECMO (veno arterial extracorporeal membran oxygenation) V-V ECMO - correct answer Enhances oxygenation, CO2 elimination and extracorporeal carbon dioxide removal for lung protective ventilation and used in 92-100% of cases. It is used for patients in respiratory failure V-A ECMO - correct answer Enhances systemic O2 delivery in cardiac failure by taking blood from the right atriumand returning it to the arterial system which bypasses the heart and lu guidelines for ECMO - correct answer o Initiation under 7 days from the start of mechanical ventilation with reversable respiratory failure o PaO2/FiO2 ratio less than 80 that is persistent with PEEP greater than or equal to 10cmH and FiO2 greater than or equal to 80, or PEEP that is 15 or greatercmH2O o Uncompensated respiratory Acidosis o Pplat greater than 35 cmH2O
o If hypoxemia happens >6 hours and persist with therapies that also support gas exchange(example, proning) ECMO timing and duration - correct answer The average length of ECMO was 13 to 20 days, with initiation typically occurring 3 to 6days after the start of mechanical ventilation ECMO ventilator guidelines - correct answer PEEP: 10-15 cm H2O Pplat: <25 cm H2O Driving Pressure: <15 cm H2O Respiratory Frequency: 4-10 breaths/min targeted SpO2: >85% FiO2: <50% absolute contraindications with ECMO and Covid- 19 - correct answer o Advanced age o Clinical frailty score > 3 o Mechanical ventilation > 10 days o Significant underlying comorbidities o Severe multiorgan dysfunction syndrome o Severe acute neurologic injury o Uncontrolled bleeding o Inability to receive blood product relative contraindications with ECMO and COVID- 19 - correct answer o Age > 65 years o Body mass index > 40 o Immunocompromised
what was shown to impact delivered humidity of heated humidification and HMEs - correct answer changes in envoronemental conditions Post-extubation stridor for COVID-19 has been attributed to a much greater rate byseveral groups associated with: - correct answer โ Prolonged intubation โ Excessive airway cuff pressures โ Agitation โ Multiple intubations โ A large ETT diameter relative to the native airway Some factors that might explain the elevation in post-extubation stridor beyond anyspecific COVID-19 pathophysiology - correct answer โ Emergently intubated โ A shock โ Nursed in the prone position ARDs patients can experience - correct answer ventilator-induced lung injury due to high tidal volumes or excessive PEEP this is because the lungs are already injured (ARDS) and have a reduced amount of tissue that is able to accept the volumes and pressure reciprocal organ crosstalk - correct answer ventilator-induced lung injury that contributes to already presentinflammation therefore causing tissue injury to other organs. 3 principles of lung protective ventilation - correct answer 1) Use of physiological tidal volumes (4-8 mL/kg) This in turn keeps the Pplat below 30 cm H2O and the driving pressure below 15cm H2O
- Adequate PEEP levels to regain normal FRC values (<15 cm H2O)
- Use the least amount of oxygen (preferrably < 0.60) possible to achieve appropriatePaO2. the most recent research supports the use of APP to - correct answer delay intubation in individuals with acute hypoxemic respiratory failure caused by COVID- 19
patients who require advanced respiratory support such as HFNC, CPAP/NIV should use - correct answer APP it is advised that the use of APP is for - correct answer 8 hours everyday efforts should be made to help in improving patient compliance/tolerance to APP prolonged prone positioning for 24 hours rather than 16 hours could help - correct answer minimize the need for repositioning, but further research is needed to determine it safety and efficacy gas is delivered to the hospital via - correct answer a series of pipes od varying sizes depending upon position in the system and intended endpoint the size of pipes serving in the ICU are - correct answer larger than on general floors advantage of the hsopital-based liquid oxygen (LOX) system is - correct answer a liter of oxygen evaporates into 860 L of gaseous oxygen emergency back up systems in hospitals include - correct answer room-size oxygen concentrators banked cylinders portable liquid systems the pandemic stressed oxygen systems because of - correct answer the unusual high oxygen requirements of so many patients. oxygen deliveries had to be more frequent to meet demands piping system goes to the floors called - correct answer risers piping turns horizontally to feed the bed spaces on that floor called - correct answer laterals lateral have a zone valve that allows that portion to be isolated within the piping system there are choke points. choke points represent - correct answer epresent narrowing of the gasdelivery system and increased resistance reducing flow distal to the choke point, negativelyimpacting high gas consumption therapies The higher the flow through these lines, and the smaller the diameter, the greater the pressure drop
clinical experience with shared ventilation - correct answer The clinical experience concluded that the ventilator must be put in pressure control modebecause in volume control if one patient had a pneumo all of that tidal volume would be divertedto the other patient The main goal is to have a titratable Vt and pressure for each patient. To do this the inspiratoryside has to connect to a Y-piece, one way valve, PEEP meter, flow meter, and HME. Theexpiratory side was set the same way but with another HME at the end of the Y-piece
