APEx – Advanced Airway & Ventilation

When checking the plateau pressure (Pplat), any pressure above ________ can cause ventilator lung injury (VLI) and possible barotrauma?

A 6-month-old, 6 kg patient recently underwent surgery and has the following ABG: pH 7.42, PaCO2 38, PaO2 52, HCO3- 25.  Current ventilator settings: SIMV 28, Vte 34, f 32, PEEP 5, FiO2 0.6. What ventilator setting changes should be made?

A 12-year-old diagnosed with diabetic ketoacidosis (DKA) is being transported. They are 5’0” and weigh 56kg. While in the ED, they have been breathing at a rate of 38 breaths per minute, and they appear fatigued. The decision to made to intubate the patient and current ABGs are requested. They are as follows: pH 7.01, PaCO2 23, PaO2 280, HCO3- 17. They are currently on a non-rebreather (NRB) at 15LPM. Which of the following plans would best suit this patient initially?

A high-pressure alarm is alerting on the transport ventilator. Any of the following can lead to this EXCEPT?

A patient has a SpO₂ of 87%. What would the associated PaO₂ be?

A patient has sustained a gunshot wound to the left chest. The left chest has been decompressed with a needle. The patient is intubated and continues to desaturate. There is a noted increase in subcutaneous air. What would be the next best intervention for this patient?

A patient is demonstrating a sudden elevated PIP with an elevated P_plat. The most likely cause is?

A patient being transported presents with minimal air movement despite having received two nebulized breathing treatments of albuterol and ipratropium.  The next best action for this patient will be:

Calculate the proper uncuffed endotracheal tube (ETT) size for a 4-year-old patient.

Dead space is calculated by using which formula?

In volume controlled ventilation, it is most appropriate to monitor ________________?

Indications for intubation of the asthmatic patient include which of the following?

Pressure regulated volume control (PRVC) mode of ventilation uses a combination of volume and pressure.  How does this mode of ventilation accomplish this?

Synchronized intermittent mandatory ventilation (SIMV) is described as what?

The main disadvantage of pressure-limited ventilation is?

The patient has the following ABG results: pH 7.10, PaCO₂ 50, HCO3^– 24, PaO₂ 92, EtCO₂ 50, SpO₂ 92%. You are attempting to manipulate the pH by increasing the patient’s minute ventilation (VE) on the transport ventilator. If you increase the VE to reflect a decrease in EtCO₂ from 50 mmHg down to 30 mmHg, what would the change in pH reflect?

The patient is demonstrating a sudden increase in peak inspiratory pressure (PIP); however, there is a normal plateau pressure (P_plat). The most likely cause would be?

The proper depth of a 3.5 endotracheal tube (ETT) would be?

The purpose of a trachea hook during a surgical cricothyroidotomy is to:

The team is on the scene of a motor vehicle collision (MVC), where an 8-year-old patient is fully immobilized with apparent difficulty breathing. Assessment reveals circumoral cyanosis, diminished breath sounds throughout, and shallow chest expansion. SpO₂ is 89% on a non-rebreather. Due to the patient’s poor respiratory status, the decision is made to perform rapid sequence intubation (RSI) and continue fluid resuscitation. The patient is placed on the mechanical ventilator, and after approximately 10 minutes, they are demonstrating an increasing PIP, decreasing chest expansion, and decreasing pulse oximetry. The most appropriate action is to:

The team is caring for a 60-kilogram ideal body weight (IBW) patient on a ventilator.  The patient is receiving a 300 mL tidal volume. The exhaled tidal volume is 285 mL. These settings and observations:

The transport team is taking care of a 32-week post-conceptual age neonate with hyaline membrane disease. The patient is currently being ventilated on high-frequency oscillatory ventilation. The ventilator settings have been established as amplitude 25 cmH₂0, frequency 8 Hertz (Hz), mean airway pressure 8 cmH₂0, 40% FiO₂. After your assessment, you note that the chest oscillation has diminished.  What is the next best action?

The transport team received a 450-pound patient with a current V_t of 925 mL and decreased SpO₂. What would the next best action be?

What is a normal SvO₂ (central venous oxygen concentration) range?

What is the MOST appropriate I:E ratio setting for an asthmatic pediatric patient intubated for respiratory failure?

What classification system uses numeric grading from 1 to 4 to score the views obtained during laryngoscopy?

When applying pressure support (PS) in a neonate on SIMV, what is the stopping point for allowing the patient to take a spontaneous breath?

When pre-oxygenating a rapid sequence intubation (RSI) patient, the strategy for doing so is?

When using a pressure-controlled mode of delivery, what can be expected?

You are transporting an 80-kilogram patient who is being mechanically ventilated. Current SpO₂ is 89%. The patient is currently chemically paralyzed, and lung sounds are noted to be diminished bilaterally in the lower lobes. Current ventilator settings are: SIMV 14, V_t 450, FiO₂ 0.8, PEEP 4, I:E 1:2. Manipulating which setting would be MOST beneficial to increase the patient’s SpO₂?

You have an 80-kilogram patient diagnosed with metabolic acidosis who is intubated, sedated, and currently paralyzed with long-acting medications. Prior to intubation, the patient’s initial respiratory rate was 34 breaths per minute with a corresponding EtCO₂ of 22 mmHg. What would be the most appropriate ventilator settings for this patient?

You perform a needle thoracostomy on your neonate with a suspected “air leak.” After re-evaluating the neonate, which of the following would indicate that initial treatment was NOT successful?

Your patient has sustained C2-C3 fractures after a motor vehicle collision. They arrive in the emergency department awake, alert and oriented. After approximately 30 minutes, they suddenly go into a respiratory arrest. What is the most appropriate initial airway management of this patient?