FCCS: Fundamentals of Critical Care Support Exam Review | Complete Study Guide with Questions and Verified Answers| 100% Correct (Latest 2023/ 2024 Update) Grade A Guaranteed

FCCS: Fundamentals of Critical Care Support Exam Review | Complete Study Guide with Questions and Verified Answers| 100% Correct (Latest 2023/ 2024 Update) Grade A Guaranteed

FCCS: Fundamentals of Critical Care
Support Exam Review | Complete Study
Guide with Questions and Verified Answers|
100% Correct (Latest 2023/ 2024 Update)
Grade A Guaranteed
Q: NPPV uses two levels of positive airway pressure, combining modalities of pressure support
ventilation and what?
Answer:
CPAP
Q: What is CPAP?
Answer:
continuous positive airway pressure

• Allows spontaneous breathing from a gas source at an elevated baseline system pressure (higher
  than atmospheric pressure)
• Functionally equivalent to PEEP.
  Q: By convention, PSV mode is referred to as and CPAP is referred to as
  when talking about NPPV/BIPAP
  Answer:
  PSV = IPAP
  CPAP = EPAP
  The difference between these two numbers determines the tidal volume generated.
  Q: Initiation of NPPV guidelines
  Answer:
• Do not delay intubation if needed and keep in mind the patient’s resuscitation status.
• Consider ABG analysis prior to initiation.
• Explain the procedure.
• Keep head of bed at e45°.
• Ensure appropriate mask or helmet size.
• Assess the patient’s tolerance of the mask by applying it by hand before securing the harness.
• Adjust the difference between EPAP and IPAP to achieve and effective VT and CO2 clearance.
  Adjust EPAP for alveolar recruitment in increments of 2 cm H2O per step to improve
  oxygenation. Depending on the ventilator, a similar increase in IPAP may be required to maintain
  the same VT.
• If assist-control volume ventilation is used, begin with a VT of 6 to 8 mL/kg
  (depending on the underlying pulmonary condition).
• Titrate pressures, volume, and FIO2 to achieve appropriate pH, PaO2, and PaCO2 levels.
  Ventilator changes can be made every 15 to 30 minutes.
• Follow vital signs, pulse oximetry, mental status, clinical appearance, and ABG (if indicated).
• Remember that goals of NPPV may include a respiratory rate <30 breaths/min, VT

7 mL/kg of predicted body weight, improved gas exchange, and patient comfort.

• It is also important to be cognizant that IPAP > 20 cm H2O may lead to gastric distension.
  Q: What are the goals of NPPV?
  Answer:
  The goals of NPPV may include a
• respiratory rate <30 breaths/min
• VT >7 mL/kg of predicted body weight
• improved gas exchange
• patient comfort.
  Q: Initial NPPV settings
  Answer:
  Use the following initial ventilator settings:
• Mode: Spontaneous
• Trigger: Maximum sensitivity
• FIO2: 1.00
• (PEEP) EPAP: 4-5 cm H2O
  ** (higher levels are poorly tolerated initially)
• (PSV) IPAP: 10-15 cm H2O
• Backup rate: Start at 6/min

Q: CPAP indications, pros, cons
Answer:

• CPAP alone can also be delivered noninva- sively but does not provide support of ventilation.
• CPAP allows spontaneous breathing from a gas source at an elevated baseline system pressure
  (higher than atmospheric pressure) and is functionally equivalent to positive end-expiratory
  pressure (PEEP).
• uncomfy
• primarily used to treat OSA
  Q: DRUGS USED TO FACILITATE TRACHEAL INTUBATION – Fentanyl
  Dose : Benefits:
  Cautions:
  Answer:
  Fentanyl
  Dose: 0.5-2ug/kg IV bolus every several minutes, titrated for analgesia. Benefits: Rapid onset,
  short acting, reversible w/ naloxone
  Cautions: chest wall rigidity w/ rapid administration, respiratory depression, does not inhibit
  awareness of procedure
  Q: DRUGS USED TO FACILITATE TRACHEAL INTUBATION – Midazolam
  Dose: Benefits:
  Cautions:
  Answer:
  Midazolam
  Dose: 0.1-0.3mg/kg bolus, titrated to sedate
  Benefits: Provides amnesia, rapid onset, short acting, reversible w/ fumazenil
  Cautions: Added respiratory depression when combined w/ narcotics
  Q: DRUGS USED TO FACILITATE TRACHEAL INTUBATION – Etomidate
  Dose:Benefits:

Cautions
Answer:
Etomidate
Dose: 0.1-0.3mg/kg single IV bolus
Benefits: provides hypnosis, MAY be preferred in head injury, NO adverse CV effects Cautions:
May induce myoclonus including mild trismus (consider pre-medicating w/ fentanyl), NO
reversal agent, transient adrenal suppression
Q: DRUGS USED TO FACILITATE TRACHEAL INTUBATION – Lidocaine
Dose:Benefits:
Cautions
Answer:
Lidocaine
Dose: 1-1.5mg/kg IV bolus 2-3 min before laryngoscopy
Benefits: blunts hemodynamic and tracheal response to intubation, may reduce ICP
during laryngoscopy
Cautions: should not exceed 4mg/kg due to neurotoxicity (seizures)
Q: DRUGS USED TO FACILITATE TRACHEAL INTUBATION – Ketamine
Dose:Benefits:
Cautions
Answer:
Ketamine Dose: 1-4mg/kg IV bolus
Benefits: Rapid onset, no adverse CV effects (exception in severe CHF), short acting Cautions:
May increase ICP, hallucinations, consider a small dose of benzo like midazolam as an adjunct.
Q: DRUGS USED TO FACILITATE TRACHEAL INTUBATION – Propofol
Dose:Benefits:
Cautions
Answer:
Propofol Dose: 1-2mg/kg IV bolus
Benefits: rapid onset, short acting, provides amnesia
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