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Average urine output per hour is approximately? - ✔✔40 mL
According to the Berlin Criteria, a patient is classified with severe ARDS when his Pao2/Fio2 ratio is? - ✔✔Less than 100
A patient is admitted to the ED with a possible CVA. Which diagnostic test is most appropriate for
identification of an acute cerebral infarction? - ✔✔CT Scan: checks chest, abdomen and brain (2- dimensions)
Cerebral angiography - ✔✔measures abnormal cerebral circulation
PET scan - ✔✔checks for cancer, brain disorders and heart diseases
A patient has been intubated in the ED and has a end tidal CO2 reading of 4%. The specialist should suspect that the:
A. patient has a pulmonary embolus
B. ET tube is in the correct position
C. ET tube is in the esophagus
D. ET tube is in the right main stem bronchus - ✔✔B. ET tube is in the correct position
*etco2 will be > if in the esophagus
Post-operatively, Mr. Hart has a 2-3 mm ST segment elevation on his 12 lead electrocardiograph. This is
indicative of - ✔✔Myocardial injury
Which of the following would most accurately provide necessary information regarding fluid management in the care of a critically ill patient with pulmonary edema?
A. Bedside PFT
B. Intake and Output measurements
C. Daily weights
D. Pulmonary artery catheter - ✔✔D. Pulmonary artery catheter
A patient who was struck in the head with a blunt object is recovering in the ICU. He is angry, combative, and irritable. He opens his eyes, grunts, and withdraws when the sole of his foot is stimulated with a
sharp object. What is his score on the Glasgow Coma scale? - ✔✔ 8
Chest radiograph changes associated with congestive heart failure include:
- Bilateral radiolucency
- Increased pulmonary Vasculature
- Cardiomegaly
A. 1 & 2 only
Which of the following tests should the adult critical care specialist recommend in order to confirm the diagnosis of pulmonary artery hypertension?
A. pulmonary functions tests
B. high resolution CT scan
C. Right heart catheterization
D. Six minute walk test - ✔✔C. Right heart catheterization
A 76 y.o. male presents to the ED with shortness of breath. Upon entering the room the adult critical care specialist determines that the patient is alert and anxious on oxygen at 5L/min by nasal cannula. He is seated in the tripod position and using accessory muscles to breathe. He has audible crackles bilaterally, jugular venous distension, and +2 peripheral edema. The following patient data is obtained:
HR 110/min
RR 31/min
BP 154/92 mmHg
Spo2 90%
Which of the following tests should the specialist recommend to confirm a suspicion of congestive heart failure?
A. troponin
B. brain natriuretic peptide
C. magnesium level
D. MB fraction of creatinine phosphokinase - ✔✔B. Brain natriuretic peptide
The adult critical care specialist assigned to the cardiovascular intensive care unit hears an alarm sound in Room 4. Upon entering the room, the specialist notes that the pulmonary artery pressure tracing is dampened. The specialist should: - ✔✔flush the catheter
- dampening means it's wet and not reading
Mrs. Smith is in her third postoperative day following repair of fractured hip. A chest radiograph obtained tis morning reveals a left lower lobe infiltrate. Patient assessment data includes:
Temp: 102F (39C)
HR 100, RR 24, Sat 92%, BP 90/
RBC 4, Hb 11
Hct 39, WBC 20000, Platelets 250,
What therapy should the specialist recommend?
A. anti-infective agent
B. beta agonist aerosol
C. sustained maximal inspiration
D. oral expectorant - ✔✔A. anti-infective agent
Mr. Jones is admitted to the critical care unit with a 2-day history of vomiting and abdominal pain. His admission lab results include:
Glucose 256
Na+ 133
K+ 5.
Cl- 95
Hco3 15
ABG: 7.28, 35 co2, 88 Pao2, 98%, 16
The specialist should initially recommend administration of: - ✔✔Insulin
Norma values:
Glucose <
Na+ 135-
K+ 35-
Cl- 95-
HCO3 22-
Ms. Brown presents with acute shortness of breath and chest pain during the last trimester of her pregnancy. She complains of dizziness and anxiety with a heart rate of 125/min and blood pressure of 80/50 mmHg. Which of the following diagnostic procedures should the adult critical care specialist recommend?
- Cerebral angiogram
- Ventilation-perfusion scan
- Arterial blood gas
- PET scan - ✔✔2 & 3
The adult critical care specialist is summoned to the ICU where a male patient with a past history of tobacco abuse and tuberculosis recently coughed up approximately 1 cup of bright red blood. He appears uncomfortable and in respiratory distress. Auscultation reveals rhonchi that are more pronounced on the right than the left. The chest radiograph demonstrates diffuse bilateral infiltrates. During the physical exam, the patient coughs up 450 mL of bright red blood.
Vital signs:
BP 110/
HR 115
RR 33
Sat 92
O2 NRB at 12lpm
Lab results are:
WBC 12,
HCT 12%
Platelets 375,
BUN 48
Her urine output is 15-20mL/hr with a net fluid balance of +8L. Chest radiograph reveals bilateral, large pleural effusions. The following patient data is available:
Hr 125
BP 90/
Creatinine 4
BUN 70
Bilirubin Normal
The critical care specialist should recommend initation of treatment for:
A. acute renal failure
B. Congestive heart failure
C. Hypervolemia
D. Hepatic failure - ✔✔A. acute renal failure
A 23y.o. man was admitted to the ED following a high - speed motor vehicle crash. He is exhibiting transient hypotension and tachycardia. The patient has multiple orthopedic injuries in addition the trauma to the right chest, pelvis and head. The radiologist noted the presence of a deep sulcus sign on the patient's AP supine chest radiograph. the nurse asks the critical care specialist the significance of this finding. The specialist should explain that the deep sulcus sign is indicative of: - ✔✔pneumothorax
A 74 y.o. man with a history of atrial fibrillation presents to the D with Hemoccult-positive stools. He is on multiple medications for diabetes and hypertension, as well as warfarin but he has been noncompliant. He has mild mitral valve regurgitation and an ejection fraction of 32% and has had
episodes of transient cerebral ischemia in the past. The specialist should report which of the following results that indicate active bleeding?
- INR of 3.
- platelet count of 300,
- Prothrombin time of 35 sec
- hematocrit of 42% - ✔✔B. 3 only
Hint: "active bleeding"
Normal:
INR 0.8-1.2 or 2-
Platelet 150,000-400,
Prothrombin Time 12-15 secs
Hematocrit 40-50%
A 50 year old male present to the Ed with syncope and shock. He is admitted to the intensive care and pulmonary artery catheter is inserted. patient data is as follows:
BP 70/
MAP 50
CVP 20
RV 45/
PAP 45/
PAP 25/
Mean PAP 14
PCWP 8-
Qt 4-
SVR <20 or 1600dynes (Left heart system)
PVR <2.5 or 200 dynes (Right heart - pulmonary sytem)
Left heart failure (>PCWP, <MAP, <QT)
Right heart failure (>CVP, <PAP)
Hypervolemia (all values are increased >)
An 82 year old man is admitted to the ICU with tachypnea, confusion, and hypotension. Initial assessment reveals:
BP 80/
MAP 60
RV 42/
PAP 45/
PCWP 8
Qt 6.
SVR 7.4 (590 dynes)
PVR 2.6 (210 dynes)
ABG on RA are: 7.45, 32, 50 o2, Sat 85%
VBG on RA are: 7.40, 38, 37o2, Svo2 70%. Ca-Vo2. Difference is 3.0 vol%
The adult critical care specialist should recommend that the patient be treated quickly for:
A. pulmonary hypertension
B. mitral valve stenosis
C. septic shoc
D. hypervolemia - ✔✔Pulmonary hypertension due to >PAP and >CVP
Indications for:
Mitral Valve stenosis= Lt heart, >PCWP, <MAP, <Qt
Septic shock =
Hypervolemia = all values are elevated (fluid overloaded)
Normal:
BP 120/
MAP 90
CVP 10
RV 25/
The ACCS should recommended that the pt be treated quickly for:
A. hypovolemic shock
B. Tricuspid valve stenosis
C. Right heart failure
D. Congestive heart failure - ✔✔A. hypovolemic shock
Indications for:
tricuspid valve stenosis = Rt side (>CVP, <PAP)
Right heart failure = (>CVP, <PAP)
Congestive heart failure = Lt side, >PCWP, <MAP, <Qt
Normal:
BP 120/
MAP 90
CVP 10
RV 25/
PAP 25/
Mean PAP 14
PCWP 8-
Qt 4-
SVR <20 or 1600dynes (Left heart system)
PVR <2.5 or 200 dynes (Right heart - pulmonary sytem)
Twenty four hours later the Pt in the previous question is anxious and complaining of respiratory distress.
RR 32
BP 80/
MAP 60
CVP 4
RV 45/
PAP 45/
Mean PAP 13
PCWP 4
Qt 3.
SVR 19.7 (1570dynes)
PVR 3.0 (240 dynes)
ABG on RA are: 7.46, 32, 55 o2, Sat 89%
VBG on RA are: 7.40, 31, 35o2, Sat 65%
Ca-Vo2 Difference is 4.8 vol%.
The ACCS should contact the attending physician and report that the patient has developed:
PVR <2.5 or 200 dynes (Right heart - pulmonary sytem)
An 88 y.o. woman arrives at the hospital confused and hypotensive. Available patient assessment data:
BP 80/
MAP 60
CVP 12
RV 40/
PAP 40/
Mean PAP 33
PCWP 29
Qt 2.
SVR 19.2 (1530 dynes)
PVR 1.6 (130 dynes)
ABG RA: 7.30, 45, o2 60, Sat 90
VBG RA: 7.26, 50, O2 28, Svo2 49
Ca-Vo2 Difference is 8.2 vol%
The ACCS should report that the pt has developed:
A. Congestive heart failure
B. Hypovolemia
C. Cor Pulmonale
D. Pulmonary hypertension - ✔✔A. Congestive heart failure (lt heart, >PCWP, <MAP, <Qt)
Indications for:
Hypovolemia = decreased values
Cor pulmonale = Rt side, >CVP, <PAP
Pulmonary hypertension = PVR is >2 or 200 dynes
Normal:
BP 120/
MAP 90
CVP 10
RV 25/
PAP 25/
Mean PAP 14
PCWP 8-
Qt 4-
SVR <20 or 1600dynes (Left heart system)
PVR <2.5 or 200 dynes (Right heart - pulmonary sytem)
A 55 y.o. male is admitted with a two week history of shortness of breath and dyspnea. The chest radiograph reveals a large left pleural effusion and atelectasis of the left lower lobe. Which of the
