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CRT & WRRT 1.3

Review for the CRT and WRRT.
STUDY
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How much pressure does a full O₂ cylinder contain?
2200 psig
The "H" cylinder holds _____ cubic feet of O₂; while the "E" cylinder holds _____ cubic feet of O₂.
The "H" cylinder holds 244 cubic feet of O₂; while the "E" cylinder holds 22 cubic feet of O₂.
What are the two types of safety releases on oxygen tanks?
1. Frangible disk (breaks at 3000 psig)
2. Fusible plug (melts at 208° - 220°)
There is a color code system for tanks of oxygen. Tell me what are the colors for the following tanks:

1. Oxygen
2. Helium
3. CO₂
4. Nitrous Oxide
5. Cyclopropane
6. Ethylene
7. Air
1. Oxygen = green (white internationally)
2. Helium = brown
3. CO₂ = gray
4. Nitrous Oxide = light blue
5. Cyclopropane = orange
6. Ethylene = red
7. Air = yellow
A star next to the latest test date on an oxygen tank means the next test must be done ______ years from that date.
A star next to the latest test date on an oxygen tank means the next test must be done 10 years from that date.
With a Thorpe flowmeter (or uncompensated flowmeter), back pressure does what?
Gives a false reading. Flowmeter reading ins lower than what the patient is actually receiving.

As opposed to a compensated flowmeter. This type will accurately display flow when back pressure is applied.
Is a Bourdon gauge compensated or uncompensated?
Uncompensated. This means back pressure gives a false reading. However, the Bourdon gauge will display the same reading whether it is horizontal or vertical.
What is the O₂ delivery and flow rates for NASAL CANNULA?
24% - 40%

1-5 L/min
What is the O₂ delivery and flow rates for SIMPLE MASK?
35% - 50%

5-10 L/min
What is the O₂ delivery and flow rates for PARTIAL REBREATHER?
40% - 70%

8-15 L/min
What is the O₂ delivery and flow rates for NON-REBREATHER MASK?
60% - 100%

10-15 L/min
If the patient's VT is fluctuating and not consistent or the respiratory rate is above 25, what type of O₂ delivery device should you use?
High flow (e.g. air entrainment mask, aerosol mask, or any device attached to a nebulizer)
True / False

Increasing the flow rate on high-flow devices will NOT increase FIO₂.
True
What is the O₂ delivery and flow rates for AEROSOL MASK?
21% - 100%

8-15 L/min

Mist should be visible at all times to ensure adequate flow rates.
What is the O₂ delivery and flow rates for FACE TENT?
21% - 40%

8-15 L/min
What is the O₂ delivery and flow rates for T-TUBE OR BRIGGS ADAPTOR?
21% - 100%

8-15 L/min

Adequate flows are ensured by visible mist flow out of the 50 mL reservoir at all times.
What is the O₂ delivery and flow rates for TRACHEOSTOMY MASK?
35% - 60%

10-15 L/min


Adequate flows are ensured by visible mist flow out of the exhalation port at all times.
What is the O₂ delivery and flow rates for OXYGEN TENT?
21%-50%

10-15 L/min
What is the O₂ delivery and flow rates for HIGH-FLOW CANNULA?
up to 80%

8 L/min (infants)
40 L/min (adults)
List the air/O₂ ratios for the following O₂ percents:

60%
40%
35%
30%
24%
60% = 1:1
40% = 3:1
35% = 5:1
30% = 8:1
24% = 25:1
Give four examples of high-flow O₂ delivery devices.
1. Venturi Mask
2. Aerosol Mask
3. T-piece (Brigg's Adaptor)
4. Face Tent
5. Trach Collar
Calculate total O₂ content, given the following ABG test results:

pH 7.36
PCO₂ 40
PO₂ 82
SaO₂ 96%
Hb 13 g/dL
17 vol %

(1.34 x 13 x 0.96) + (82 x .003) = 16.95
What is the total flow delivered by an aerosol mask on 60% O₂, running 12 L/min ?
24 L/min

60% (1:1 air/O₂ ratio)
1+1 = 2, 2 x 12 L/min = 24 L/min
List the three ventilatory criteria that should be met by patients receiving O₂ from a low-flow device.
1. Consistent ventilatory pattern
2. VT 300 - 700 mL
3. Respiratory Rate < 25
An 80:20 mixture of helium/O₂ running through an O₂ flowmeter at 6 L/min is delivering how much flow to the patient?
10.8 L/min

1.8 x 6 = 10.8 L/min
Calculate how long an "E" cylinder with 1900 psig will run at 5 L/min.
1 h, 46 min

(1900 x .28) / 5 = 106 min
Give examples of three low-flow O₂ devices.
1. nasal cannula
2. simple mask
3. partial rebreather
List five conditions that affect the accuracy of pulse oximeters.
1. poor perfusion
2. severe anemia
3. hypotension
4. elevated HbCO level
5. direct light
6. nail polish
7. dark skin
How does water in the aerosol tubing of a mask affect the delivered FIO₂?
Increases FiO₂
The physician orders O₂ therapy for a patient with a VT of 400 mL and an inspiratory time of 0.5 seconds. What flow must the mask deliver to meet this patient's inspiratory flow demands?
48 L/min

0.4L / 0.5s = 0.8 L/sec * 60 = 46 L/min
Name the four critical life functions.
1. Ventilation (moving air in/out of lungs)
2. Oxygenation (getting oxygen into blood)
3. Circulation (moving blood through body)
4. Perfusion (getting blood/oxygen into the tissue)
The activities of daily living (ADL) scale is based on six criteria. Fill in the missing.

1. bathing
2. eating
3. dressing
4.
5.
6.
1. bathing
2. eating
3. dressing
4. toilet use
5. transferring
6. urine and bowel continence

If a patient is able to do each, a score of '1' is assigned. A total score of 2 or less means patient is impaired.
Orthopnea means what?
difficulty breathing except in the upright position. This may be due to CHF or other heart problem.
There are five grades of dyspnea. Which is worse?
I. dyspnea occurs after unusual exertion.
II. breathless after going up hills/stairs
III. dyspnea while walking at normal speed
IV. dyspnea slowly walking short distances
V. dyspnea at rest, shaving, dressing
True / False

Lung tissue is not pain sensitive.
True
True / False

Ribs and pleura are not sensitive to pain.
FALSE
Why would you do a capillary refill test?
This is commonly done for the modified Allen's test before drawing an ABG.
What is erythema?
redness of the skin. May be due to capillary congesting, inflammation, or infection.
What is kyphosis?
convex curvature of the spine (lean forward)
What is barrel chest indicative of?
Air trapping in the lungs for a long period of time. This increases the A-P diameter.
What would unequal (asymmetrical) movement of the chest indicate?
1. chronic lung disease
2. atelectasis
3. pneumothorax
4. flail chest
5. intubation of one lung
Name the following breathing pattern:

Normal respiratory rate (12-20 breaths/min).
Eupnea
Name the following breathing pattern:

Rate > 20 caused by hypoxia, fever, pain, CNS problem.
Tachypnea
Name the following breathing pattern:

Rate < 12 caused by sleep, metabolic disorders
Bradypnea
Name the following breathing pattern:

cessation of breathing
Apnea
Name the following breathing pattern:

increased rate, depth, regular rhythm
Hyperpnea
Name the following breathing pattern:

gradually increasing then decreasing rate and depth in a cycle lasting from 30-180 seconds with periods of apnea lasting up to 60 seconds.
Cheyne Stokes

causes: ↑ ICP, meningitis, drug overdose
Name the following breathing pattern:

increased respiratory rate and depth with irregular periods of apnea. Each breath has the same depth.
Biots

causes: CNS problem
Name the following breathing pattern:

increased respiratory rate (usually over 20 breaths/min), increased depth, irregular rhythm, breathing sounds labored.
Kussmaul's

causes: metabolic acidosis, renal failure, diabetic ketoacidosis
Name the following breathing pattern:

prolonged gasping inspiration followed by extremely short, insufficient expiration.
Apneustic

causes: problem with respiratory center, trauma, tumor
What is the term for muscle wasting?
Atrophy

May also be refereed to as Cachetic
Name the accessory muscles of ventilation.
1. Internal intercostals
2. Scalenes
3. Sternocleidomastoid
4. Pectoralis Major
5. Abdominals (oblique, rectus abdominus)
Name the normal muscles of ventilation.
1. Diaphragm
2. External intercostals
The existence of clinical factors that complicate either ventilation or intubation may be seen externally on face or neck. Name some of these features.
1. short receding mandible
2. enlarged tongue (macroglossia)
3. Bull neck
4. limited range of motion of neck
What type of IPPB machine is preferred for the home care setting?
The Bennett AP-5 is commonly used because it operates on electricity rather than compressed gas.
Name three common breathing exercises that a therapist might teach a patient in the home care setting.
1. Pursed-lip breathing
2. Diaphragmatic breathing
3. Segmental breathing
A VC of ________ of ideal body weight (IBW) indicates inadequate volume for an effective cough.
A VC of 10 to 15 mL/kg of ideal body weight (IBW) indicates inadequate volume for an effective cough.
A liquid oxygen tank can hold up to _____ times more oxygen than a cylinder.
860
True / False

Liquid oxygen is safer than gas stored high-pressure cylinders.
True
In the home care setting, a good supply system of O₂ for the patient who uses high volumes would be what?
liquid oxygen
Name the two types of O₂ concentrators.
1. Membrane (produces only 40%)
2. Molecular Sieve (produces 90-95%) most common
What type of O₂ should be used as backup and how much of it should be stored?
Cylinder O₂

1-3 days supply.
True / False

The higher the flow rate used on a concentrator, the less the delivered O₂ percentage.
True
Nebulizing 10mL of _______ through nebulizers and room humidifiers is an appropriate cleaning technique. Conversely, allowing it to soak in this is also an acceptable method of disinfection.
Nebulizing 10mL of VINEGAR through nebulizers and room humidifiers is an appropriate cleaning technique. Conversely, allowing it to soak in this is also an acceptable method of disinfection.
Cannulas in the home setting should be replaced every:

a. 1-2 weeks
b. 2-4 weeks
c. 4-6 weeks
d. 6-8 weeks
b. 2-4 weeks
List four goals of rehabilitiation.
1. Help patient become independent
2. Cope with disease
3. Understand disease and its limitations
4. Set realistic goals and ways to attain them
List five periodic evaluations of the home care patient that should be conducted by the RCP.
1. PFTs
2. Sputum collection/analysis
3. ABGs
4. Exercise Tolerance Testing
5. CXR films
How does pursed-lip breathing benefit patients with emphysema?
This creates a subtle back pressure in the larger airways which reduces the volume of trapped air and helps to reduce the feeling of dyspnea.
What type of evaluations should be made by the RCP regarding the O₂ concentrators during routine visits?
1. FIO₂ analysis
2. Alarm checks
3. Flow measurements
4. Filter/Battery checks
Calculate how long 3 lb of liquid oxygen running through a 2 L/min nasal cannula will last.
8.6 hours

(3 x 860) / 2 = 1032 L

1032 L / 2 L/min = 516 min or 8.6 hours
Name the four initial ventilator parameters in the order of their importance. AND their settings for adults.
1. VT (8-12 mL/kg of IBW. 10 mL/kg is best)
2. RR (8-12. 10 is best)
3. Mode (SIMV over A/C)
*4. FIO₂ and PEEP

*If there is no information about prior O₂ or room air use 40-60%.

If pt. was on O₂ and/or CPAP before then use the same FIO₂ and/or PEEP.

An emergency involving lung damage (CO poisoning, edema, flail chest) use 100%.
Name the initial ventilator parameters AND their settings for infants.
Mode: IMV / SIMV
1. RR (20-30) breaths/minute
2. Pressure: 20-30 cmH₂O
3. FIO₂: same as adults
4. PEEP: 2-4 cmH₂O (increase by 1 or 2 with max at 8 cm/H₂O)
5. 5-6 L/min
6. TI: 0.5 - 0.6 sec

Remember: If the patient is already receiving O₂ and CPAP, start at the SAME LEVEL.
Name the four physiologic variables that blood-gas-analysis monitors.
1. PaO₂ (arterial oxygenation)
2. PaCO₂ (alveolar ventilation)
3. pH (acid-base status)
4. PṽO₂ (O₂ delivery to tissues)
Air in the blood sample causes ________ PaO₂ and _____________ PaCO₂ levels.
Air in the blood sample causes INCREASED PaO₂ and DECREASED PaCO₂ levels.
If the patient is febrile, this will shift the oxyhemoglobin (HbO₂) curve to the __________, indicating that Hb more readily __________ O₂ but does not pick up the ________ as easily.
If the patient is febrile, this will shift the oxyhemoglobin (HbO₂) curve to the RIGHT, indicating that Hb more readily RELEASES O₂ but does not pick up the O₂ as easily.
True / False

The PaO₂ is the portion of O₂ that is dissolved in the plasma of the blood.
True

It is what is left over after the Hb molecules have been saturated.
For every 1 mmHg of PaO₂, there is _____ mL of dissolved O₂.
For every 1 mmHg of PaO₂, there is 0.003 mL of dissolved O₂.
What relationship does the HbO₂ dissociation curve plot?
The oxyhemoglobin dissociation curve plots the relationship between:

1. PaO₂ (x-axis)
2. SaO₂ (y-axis)
The HbO₂ dissociation curve indicates that at PaO₂ levels of less than ___________, small increases in _______ result in fairly large increases in _______.
The HbO₂ dissociation curve indicates taht at PaO₂ levels of less than 60 mmHg small increases in PaO₂ result in fairly large increases in SaO₂.
The flat portion of the HbO₂ dissociation curve indicates that at PaO₂ levels above _______, saturation rises _______.
The flat portion of the HbO₂ dissociation curve indicates that at PaO₂ levels above 60 mmHg saturation rises SLOWLY.
The oxyhemoglobin dissociation curve shifts to the ______ during the Haldane effect. Give the four effects/causes involved with this shift.
The oxyhemoglobin dissociation curve shifts to the LEFT during the Haldane effect.

↑ pH (alkalosis)

↓ PCO₂ (hypocapnia)
↓ Temp (hypothermia)
↓ 2,3 DPG

This effect occurs at the LUNG level.
The oxyhemoglobin dissociation curve shifts to the ______ during the Bohr effect. Give the four effects/causes involved with this shift.
The oxyhemoglobin dissociation curve shifts to the RIGHT during the Bohr effect.

↓ pH (acidosis)

↑ PCO₂ (hypercapnia)
↑ Temp (hyperthermia)
↑ 2,3 DPG

This effect occurs at the TISSUE level.
Define the following levels:

1. Mild Hypoxia
2. Moderate Hypoxia
3. Severe Hypoxia
1. 60-79 mmHg: Mild Hypoxia
2. 40-59 mmHg: Moderate Hypoxia
3. 00-39 mmHg: Severe Hypoxia
How much CO₂ gets dissolved in the plasma?
5%

The remaining 95% enters the RBCs.
Name the three ways that CO₂ is carried in the blood?
1. plasma
2. Hb
3. As HCO₃¯
The adequacy of ventilation is determined by the ____________ level.
The adequacy of ventilation is determined by the PCO₂ level.
For every _______ mmHg decrease in PaCO₂, the pH increases by ________.
For every 10 mmHg decrease in PaCO₂, the pH increases by 0.10.
For every _______ mmHg increase in PaCO₂, the pH decreases by ________.
For every 20 mmHg increase in PaCO₂, the pH decreases by 0.10.
Which electrode measures pH.

a. Sans
b. Clark
c. Severinghaus
a. Sans
Which electrode measures PCO₂.

a. Sans
b. Clark
c. Severinghaus
c. Severinghaus
Which electrode measures PO₂.

a. Sans
b. Clark
c. Severinghaus
b. Clark
What type of calibration should be performed before a blood gas sample is run unless the analyzer automatically performs this calibration at programmed intervals.

a. two-point calibration
b. three-point calibration
c. one-point calibration
d. no point calibration
c. one-point calibration
This type of calibration is usually performed every 8 hours.

a. two-point calibration
b. three-point calibration
c. one-point calibration
d. no point calibration
a. two-point calibration
True / False

A buffer is used to perform a two-point calibration.
FALSE

Two buffers are used to perform a two-point calibration. One buffer on the one-point.
Interpret the following blood gas values:

pH 7.21
PCO₂ 43
PO₂ 81
HCO₃¯ 14
Uncomp. metabolic acidosis with normal oxygenation
Interpret the following blood gas values:

pH 7.36
PCO₂ 62
PO₂ 58
HCO₃¯ 36
Fully Comp. (chronic) respiratory acidosis with moderate hypoxia
Interpret the following blood gas values:

pH 7.57
PCO₂ 27
PO₂ 89
HCO₃¯ 24
Uncomp. respiratory alkalosis, with normal oxygenation
Interpret the following blood gas values:

pH 7.22
PCO₂ 51
PO₂ 71
HCO₃¯ 17
Combined respiratory and metabolic acidosis with mild hypoxemia
Interpret the following blood gas values:

pH 7.44
PCO₂ 28
PO₂ 80
HCO₃¯ 18
Fully compensated respiratory alkalosis with normal oxygenation
Interpret the following blood gas values:

pH 7.32
PCO₂ 52
PO₂ 84
HCO₃¯ 31
Partially compensated respiratory acidosis with normal oxygenation
What do the results of an Allen test mean?
An Allen test is done before radial artery puncture to determine collateral blood flow to the hand. It is essential to determine if ulnar blood flow is present, in case the radial artery spasms or clots.
What conditions shift the HbO₂ dissociation curve to the right?
↓ pH (acidosis)

↑ PCO₂ (hypercapnia)
↑ Temp (hyperthermia)
↑ 2,3 DPG

This effect occurs at the TISSUE level.
When the HbO₂ curve is shifted to the right, how is the affinity of Hb for O₂ affected?
When the curve shifts to the right, the Hb affinity for O₂ decreases, which makes O₂ binding more difficult; however, the O₂ that does bind with Hb wil be released more easily to the tissues.
Calculate the P(A-a)O₂ given the following data:

PB: 747 mmHg
ABGs on 40% O₂: pH 7.42, PCO₂ 45, PO₂ 80, HCO₃¯ 25
144 mmHg

PAO₂ = ([747-47] 0.40) - (45 * 1.25)
280-56 = 224

PAO₂ - PaO₂ = 224-80 = 144
Which ABG value best reflects the patient's ability to ventilate?
PaCO₂
List a set of ABG levels that are typical of a patient with diabetic ketoacidosis?
pH 7.25, PCO₂ 23, PO₂ 80, HCO₃, 12

This is partially compensated metabolic acidemia. The initial problem is metabolic acidemia. The patient responds to this by hyperventilating to remove CO₂ which begins bringing the pH back up toward normal levels.

The answer should show that the levels of pH, PCO₂, and HCO₃ all decreased.
What is egophony?

What does it indicate?
Egophony is when the patient says "E" but it sounds like "A".

This indicates consolidation of the lung tissue as with a pneumonia-like condition.
What term(s) would one use to indicate "normal" breath sounds on auscultation?
1. vesicular: normal sounds in both lungs.

2. bronchial: normal sounds heard over trachea and bronchi. These sounds over periphery indicate lung consolidation.
What is paradoxical pulse or pulsus paradoxus?
Pulse/blood pressure varies with respiration. May indicate severe air trapping (status asthmaticus or cardiac tamponade).
Tracheal deviation may be pulled toward the abnormal side of lungs (toward pathology). Name 4 pathologies where this might occur.
1. atelectasis
2. fibrosis
3. pneumonectomy
4. diaphragmatic paralysis
Tracheal deviation may be pushed to the normal side of lungs (away from pathology). Name 4 pathologies where this might occur.
1. massive pleural effusion
2. tension pneumothorax
3. neck or thyroid tumors
4. large mediastinal mass
What is tactile fremitus?
Tactile fremitus are vibrations that are felt by hand on the chest wall.
What is crepitus?
Crepitus is bubbles of air under the skin.
Where is this percussion sound heard or indicative of:

"resonant"
normal air filled lungs.

This give a hollow sound.
Where is this percussion sound heard or indicative of:

"flat"
heard over sternum, muscles, or areas of atelectasis
Where is this percussion sound heard or indicative of:

"dull"
heard over fluid-filled organs such as the heart or liver. Pleural effusion or pneumonia will give this thudding sound.
Where is this percussion sound heard or indicative of:

"tympanic"
heard over air filled stomach. This is a drum-like sound and when heard over the lungs indicates increased volume.
Where is this percussion sound heard or indicative of:

"hyperresonant"
found in areas of the lung where pneumothorax or emphysema is present. This is a booming sound.
What is bronchophony?

What does it indicate?
Bronchophony and whispered pectoriloquy are terms that indicated increased intensity or transmission of the spoken voice.

This indicates consolidation and pneumonia.
What do rales, coarse rales, medium rales, and fine rales indicate?
1. Rales (crackles) = secretion/fluid
2. Coarse Rales = large airway secretions: suction
3. Medium Rales = middle airway secretions: CPT
4. Fine Rales = alveoli fluid: IPPB, heart drugs, diuretics
What are normal heart sounds and what letters are used to represent them?
S₁, S₂

Sounds created by the closure of the heart valves
What are abnormal heart sounds and what letters are used to represent them?
S₃, S₄

S₃ indicates cardiac abnormality (MI, megaly)
S₄ may indicate heart valve defects
What are bruits?
Bruits are the sounds made in an artery or vein when blood flow becomes turbulent or flows at an abnormal speed.
On an normal chest x-ray, what part of the diaphragm is slightly higher?
The right hemidiaphragm is slighly higher than the left. It is located at the level of the sixth anterior rib.
These organisms pose the greatest hazard for infection via respiratory therapy equipment.

a. vegetative organisms
b. spores
a. vegetative organisms

The most common equipment contaminants are NOT spore forming.
The suffix -static means what?
To prevent growth
These organisms are more resistant to both chemical and physical agents.

a. vegetative organisms
b. spores
b. spores
What must be done to equipment before the decontamination process?
washed in soapy water and rinsed off
What type of vegetative organism is most frequently encountered on respiratory equipment.

a. baccilli
b. spirillum
c. cocci
a. baccilli

These are not spore-forming.
What are three examples of bacilli?
1. Klebsiella pneumoniae (gram neg.)
2. Pseudomonas aeruginosa (gram neg.)
3. Mycobacterium (gram pos.)
4. Serratia marcescens (gram neg.)
5. Haemophilus influenzae (gram neg.)
What is the normal operating levels of autoclave?
15 minutes at 121° C and 15 psig.

Remember autoclave STERILIZES equipment.
True / False

Pasteurization disinfects equipment but spores are not killed.
True
What techniques sterilize.

1. autoclave
2. pasteurization
3. ethylene oxide gas
4. alcohol
5. glutaraldehydes
6. acetic acid
1. autoclave
3. ethylene oxide gas
5. glutaraldehydes (3-10 hours)
Which of the following is transmitted by droplet.

1. Klebsiella pneumoniae (gram neg.)
2. Pseudomonas aeruginosa (gram neg.)
3. Mycobacterium (gram pos.)
4. Serratia marcescens (gram neg.)
5. Haemophilus influenzae (gram neg.)
5. Haemophilus influenzae (gram neg.)
List four diseases that are spread by airborne pathogens.
1. TB
2. histoplasmosis
3. legionellosis
4. measles
What device should be used in the ventilation system through which air is discharge safely from the room of a patient with a disease caused by an airborne pathogen.
HEPA filter
List three diseases transmitted by the spread of droplets.
1. streptococcal pneumonia
2. epiglottitis
3. adenovirus
4. meningitis
5. pertussis
6. H. influenzae
List four gram-negative organisms that may result in necrotizing pneumonia.
1. pseudomonas
2. klebsiella
3. serratia
5. legionella
What methods are used to determine the effectiveness of the decontamination process?
1. chemical/biological indicators
2. culture and swab sampling
The following list represents the 6 main causes of upper airway obstruction. Fill in the blanks.

1. Tongue
2. Edema
3. Bleeding
4. Secretions
5.
6.
The 6 main causes of upper airway obstruction are:

1. Tongue
2. Edema
3. Bleeding
4. Secretions
5. FOREIGN SUBSTANCES
6. LARYNGOSPASM
If the patient is unconscious and has a partial or complete airway obstruction that is most likely caused by the tongue, the ____________ maneuver will help relieve the obstruction by moving the tongue forward.
If the patient is unconscious and has a partial or complete airway obstruction that is most likely caused by the tongue, the HEAD TILT AND CHIN LIFT maneuver will help relieve the obstruction by moving the tongue forward.
True / False

The oropharyngeal should NEVER be taped in place.
True
How do you measure the proper fit of an oropharyngeal airway?
Measure the airway from the corner of the lip to the angle of the jaw to ensure proper length.
What type of oropharyngeal airway is made of hard plastic and has a groove down either side to guide a suction catheter to the glottic area.

a. Guedel
b. Berman
c. Truman
d. Littman
e. none of the above
b. Berman
What type of oropharyngeal airway is made of soft, pliable material, which has an opening through the middle to allow the passing of a suction catheter into the glottic area.

a. Guedel
b. Berman
c. Truman
d. Littman
e. none of the above
a. Guedel
This type of airway maintains a patent airway by lying between the base of the tongue and the posterior wall of the pharynx.

a. oropharyngeal
b. nasopharyngeal
c. LMA
d. naso-gastric
e. endtotracheal
b. nasopharyngeal
True / False

LMAs are available in all sizes but can only be used on adults.
FALSE

LMAs are available in all sizes and can be used in patients of all ages, from neonates to adults.
What are two contraindications of LMAs.
1. health care provider not trained in LMA use
2. risk of aspiration
Is there a risk of esophageal or bronchial intubation with the LMA?
No.
Name one of the disadvantages of the LMA.
Disadvantages of LMA

1. does not provide protection against aspiration
2. cannot be used if the mouth cannot be opened more than 0.6 inches (1.5 cm)
3. many not be effective when airway anatomy is abnormal
4. may be difficult to provide adequate ventilation if high airway pressures are required
Name two of the five contraindications of esophageal-tracheal combitube (ETC).
Contraindications of the ETC


1. gag reflex
2. esophageal disease
3. caustic substance (ingestion)
4. upper airway obstruction
5. patient less than 4 ft. tall
Name two of the five disadvantages of the ETC.
Disadvantages of the ETC

1. proximal port may be occluded with secretions
2. ventilation through wrong tube
3. soft tissue trauma due to rigidity
4. no suction if tube is in esophagus
5. esophageal trauma from poor insertion technique
What is the time limit for an intubation attempt?
15 - 20 seconds
How far do you advance the ET tube past the vocal cords?
2 cm
Is it possible for the CO₂ detector to read near zero even when the ET tube is properly positioned?
Yes.

During the resuscitative procedure when cardiac output and blood pressure are low, gas exchange is reduced and the CO₂ detector may read near zero, even when the ET tube is in the trachea.
What is the average distance from the teeth to the carina?

What is the centimeter mark at the teeth?
The average distance from the teeth to the carina is 27 cm.

The tube marking is 23- to 25-cm at the teeth.
Give the appropriate ET tube sizes for newborns (by body weight).
2.5 mm - 4.0 mm

2.5 mm, < 1 kg
3.0 mm, 1-2 kg
3.5 mm, 2-3 kg
4.0 mm, > 3 kg
Give the appropriate ET tube sizes for children (by age).
3.0 mm - 7.5 mm

3.0 - 4.0 mm, 6 months
3.5 - 4.5 mm, 18 months
4.0 - 5.0 mm, 2 years
4.5 - 5.5 mm, 3 - 5 years
5.5 - 6.0 mm, 6 years
6.0 - 6.5 mm, 8 years
6.0 - 7.0 mm, 12 years
6.5 - 7.5 mm, 16 years
Give the appropriate ET tube sizes for adults (by gender).
7.5 - 9.0 mm (women)

8.0 - 9.5 mm (men)
On a radiograph, where is the carina generally seen?
The carina is seen on radiographs at the fourth rib or the fourth thoracic vertebra.
What could you clean a stoma with?
4 x 4 inch gauze pads soaked with hydrogen peroxide.

AFTER the site is cleansed, rinse the site using gauze pads dipped in sterile water.
This airway consists of a short, hollow tube that is used to replace the trach tube but can still maintain a patent stoma, in case problems arise.

a. trach button
b. Kistner trach tube
a. trach button
This airway has a one-way valve on the proximal end of the tube, allowing air to flow up through the vocal cords and out the nose/mouth.

a. trach button
b. Kistner trach tube
b. Kistner trach tube
What is the maximum pressure a cuff should have?

Please give your answer in mmHg and cmH₂O.
20-25 mmHg

25-34 cmH₂O
When suctioning a patient what is an acceptable amount of saline to instill, to help thin secretions.

Please give your answer for adults and infants.
3-5 mL (adults)

0.3 - 0.5 mL (infants)
What is the proper size of catheter to use when suctioning an 8.0 mm ET tube?
14 Fr.

To estimate the proper catheter size, multiply the internal diameter of the ET tube by 2, then use the next smallest catheter size. In this scenario 16 = 8.0 x 2. 14 French is the next size below 16.
What are the appropriate suction pressures for adults, children, and infants?
-100 to -120 mmHg (adults)

-80 to -100 mmHg (children)

-60 to -80 mmHg (infants)
When do you withdraw the ET tube when extubating?
At peak inspiration, withdraw the tube.
The following list represents laryngeal and tracheal complications of ET tubes. Fill in the blanks.

1. Sore Throat / Hoarsness
2. Edema (glottic & subglottic)
3. Ulceration (vocal cords / tracheal mucosa)
4. Paralysis (vocal cords)
5.
6.
7.
ET Tube complications

1. Sore Throat / Hoarsness
2. Edema (glottic & subglottic)
3. Ulceration (vocal cords / tracheal mucosa)
4. Paralysis (vocal cords)
5. LARYNGOTRACHEAL WEB
6. TRACHEAL STENOSIS
7. TRACHEAL MALACIA
Inspiratory stridor is a major clinical sign of what airway condition?
Glottic Edema
What is the name of the speaking valve that may be attached to a ventilator patient's tracheostomy tube that allows the patient to talk?
Passy-Muir speaking valve
Describe the purpose of an oropharyngeal airway.
The oropharyngeal airway is used to prevent upper airway obstruction, mainly from the tongue, in unconscious patients only. It may be used as a bite block for unconscious, intubated patients.
What is the primary purpose of a fenestrated tracheostomy tube?
A fenestrated tracheostomy tube is used to wean a patient from a conventional tracheostomy tube and allow the patient to speak.
What is the maximum amount of suction pressure that may be used to suction an adult's airway?
- 120 mmHg
List three medications commonly instilled directly down the ET tube.
N - A - V - E - L

1. atropine
2. epinephrine
3. lidocaine

4. naloxone hydrochloride (narcan)
5. vasopressin
What is the major indication for the administration of dopamine?
hypotension
List two indications for lidocaine.
1. Vfib
2. Vtach
Sodium nitroprusside (Nipride) is indicated for the treatment of what condition?
hypertension
Describe the proper airway management of a post-term neonate in whom meconium aspiration is suspected.
intubate and suction the airway
When resuscitating a neonate immediately after delivery , what is the proper ventilation rate and peak inspiratory pressure for manual ventilation?
1. rate: 40/min
2. PIP: 30-40 cmH₂O and subsequent pressure 15-20 cmH₂O
List four criteria that aid in delivering the highest O₂ concentration with a manual resuscitator.
1. add O₂ reservoir
2. use high O₂ flow rate (10-15 L/min)
3. use slower ventilation rate (10-20 /min)
4. avoid excessive volumes if reservoir is not used
What is the initial current delivered during defibrillation of an adult with monophasic defibrillator?

With a biphasic defibrillator?
monophasic = 360 J

biphasic = 200 J
What is the maximum current used to defibrillate an adult?
360 Joules
List two drugs that may be administered to improve the success of defibrillation.
1. lidocaine
2. epinephrine
List five arrhythmias that cardioversion is used to terminate.
1. atrial flutter
2. atrial fibrillation
3. Vtach
4. Vfib
5. paroxysmal supraventricular tachycardia
How many joules are delivered to the patient during cardioversion?
25 - 100 Joules
List three potential consequences that could affect a patient during an air transport at high altitude.
1. ↓ PaO₂
2. ↑ pneumothorax
3. ↑ ET tube cuff pressure
What should the manual resuscitator have to measure PIP?
It should have a manometer attached to it.
Name the four drugs associated with neonatal resuscitation.
1. Epinephrine (cardiac stimulant)
2. Volume expanders (whole blood, normal saline, Ringer's lactate)
3. Sodium Bicarbonate
4. Naloxone Hydrochloride (Narcan)
What are the compression/ventilation ratios for one rescuer:

adult
child
infant
adult: 30:2
child: 30:2
infant: 30:2
What are the compression/ventilation ratios for two rescuers:

adult
child
infant
adult: 30:2
child: 15:2
infant: 15:2
When rescue breathing for a patient WITH a pulse give the time frame of breaths for:

adult
child
infant
adult: one breath every 5-6 seconds (10-12 /min)
child: on breath every 3-5 seconds (12-20 /min)
infant: one breath every 3 seconds (20 /min)
The adult's cardiopulmonary status should be reassessed after _____ cycles, and the infant or child's status should be reassessed after ______ cycles.
The adult's cardiopulmonary status should be reassessed after 5 cycles, and the infant or child's status should be reassessed after 20 cycles.
Manual compressions achieve only about ____% to ____% of normal cardiac output.
Manual compressions achieve only about 25% to 35% of normal cardiac output.
There are hazards to CPR. Can you name three of them?
1. rib fractures
2. fat embolism
3. gastric distention
The following list represents ways to achieve the highest delivered O₂ levels possible when ventilating using manual resuscitators. Can you fill in the blanks.

1. reservoir attachment
2.
3.
4. do not use large stroke volumes
1. reservoir attachment
2. highest flow rate (10-15)
3. refill time (longest)
4. do not use large stroke volumes
The following list represents ways to achieve the highest delivered O₂ levels possible when ventilating using manual resuscitators. Can you fill in the blanks.

1.
2. highest flow rate (10-15)
3. refill time (longest)
4.
1. reservoir attachment
2. highest flow rate (10-15)
3. refill time (longest)
4. do not use large stroke volumes
What are the indications for epinephrine when used in emergency care?
1. asystole
2. sinus arrest
3. Vfib
What are the indications for lidocaine when used in emergency care?
1. Vfib
2. Vtach
What are the indications for atropine sulfate when used in emergency care?
1. sinus bradycardia
2. asystole
3. nodal bradycardia
What are the indications for procainamide when used in emergency care?
1. Vtach
2. Vfib
3. PVCs
What are the indications for propranolol hydrochloride when used in emergency care?
1. mycoardial infarction
2. angina pectoris
3. supraventricular arrhythmias
4. Vtach
What are the indications for dobutamine hydrochloride when used in emergency care?
1. depressed myocardial contractility
What are the indications for isoproterenol hydrochloride when used in emergency care?
1. bradycardia
2. heart block
3. hypotension
What are the indications for dopamine hydrochloride when used in emergency care?
1. hypotension
What are the indications for sodium nitroprusside (Nipride) when used in emergency care?
1. hypertension
What are the indications for calcium chloride when used in emergency care?
1. hypocalcemia
2. hyperkalemia
What are the indications for vasopressin when used in emergency care?
1. cardiac arrest
What drugs used in emergency care improve the success of defibrillation?

(hint: 2)
1. lidocaine
2. epinephrine
When a defibrillator is unavailable, what might a rescuer use instead?
Precordial Thump

The precordial thump, a sharp, quick blow delivered to the midportion of the sternum with the fleshy part of the fist, is recommended for a witnessed cardiac arrest when a defibrillator is not available.
Cardioversion is used to terminate which arrhythmias?
1. atrial flutter
2. atrial fibrillation
3. Vtach
4. parosyxmal supraventricular tach

5. Vfib (but defibrilliation is usually indicated here)
True / False

Heated humidity or aerosol for ventilators or masks during transport is not necessary for such a short-term use.
True
In pressure control ventilation, what setting is used to control VT?
PIP

Example: If target VT is 400 mL and 300 mL is being exhaled then PIP should be increased to achieve a VT of 400 mL.
Give the ARDS network guidelines for the following parameters:

VT
PEEP
pH
FiO₂
Pplat (alveolar)
PO₂: 55-80 torr
VT: 6 mL/kg of IBW
PEEP: ≤ 24 cmH₂O
pH: 7.30 - 7.45
FiO₂: ≤ 60%
Pplat: ≤ 30 cmH₂O
PO₂: 55 - 80 torr
EPAP is the equivalent to _____________.
EPAP is the equivalent to PEEP.
Give the initial settings for EPAP and IPAP for a patient about to be given BiPAP.

What is the condition for IPAP?
EPAP: 4-5 cmH₂O
IPAP: 10-15 cmH₂O

IPAP should be set for a resulting VT of 8-10 mL/kg
True / False

Breathstacking can occur in SIMV mode.
FALSE
Patients whose PaO₂ level cannot be maintained within normal limits using 60% or more O₂ mask and who have a normal or low PaCO₂ level should use:

a. Control
b. A/C
c. BiPAP
d. PSV
e. CPAP
e. CPAP
What is the equation for compliance?
Compliance = Volume / Pressure
With VT control, what is the ideal VT setting?
8-12 mL/kg of IBW

ARDS patients: 5-6 mL/kg of IBW
It is best to maintain alveolar pressure (static pressure) less than:

a. 20 cmH₂O
b. 25 cmH₂O
c. 30 cmH₂O
d. 35 cmH₂O
e. 40 cmH₂O
d. 35 cmH₂O

Anything greater may result in lung damage.
When VT ↑ what happens to the following:

VA
Ve
Ti
PaCO₂
↑ VT

↑ VA
↑ Ve
↑ Ti

↓ PaCO₂
When VT ↓ what happens to the following:

VA
Ve
Ti
PaCO₂
↓ VT

↓ VA
↓ Ve
↓ Ti

↑ PaCO₂
Anatomic dead space is equal to:

a. 3 mL/lb of IBW
b. 2 mL/lb of IBW
c. 1 mL/lb of IBW
d. 1 mL/kg of IBW
e. 2 mL/kg of IBW
c. 1 mL/lb of IBW

Remember this is in lbs NOT kilograms!
What is the normal ventilator setting for respiratory rate?
8-12 breaths/min
How does respiratory rate (f) affect the I:E ratio?
It alters the expiratory time.

↑ Rate = ↓ Te
↓ Rate = ↑ Te
When Rate (f) ↑ what happens to the following:

Te
Ve
PaCO₂
Rate (f) ↑

↓ Te
↓ PaCO₂

↑ Ve
When Rate (f) ↓ what happens to the following:

Te
Ve
PaCO₂
Rate (f) ↓

↑ Te
↑PaCO₂

↓ Ve
Adjusting the rate to alter the patient's PaCO₂ is more beneficial for patients on which ventilator mode(s)?
Control

SIMV
If a patient were on Control or SIMV mode, how would you adjust their PaCO₂?
Using Rate
How would you adjust a person's PaCO₂ if they were on A/C mode?
Using VT
What is the normal ventilator setting for inspiratory flow?
40-60 L/min
How does flow setting affect the I:E ratio?
Flow alters the Ti. The two have an inverse relationship.

↑ Flow = ↓ Ti
↓ Flow = ↑ Ti
What three ventilator controls establish the I:E ratio?
1. VT
2. Flow
3. Rate (f)
How does VT affect the I:E ratio?
VT alters the Ti. The two have a direct relationship.

↑ VT = ↑ Ti
↓ VT = ↓ Ti
What is calculation for Ti?
Ti = Total Cycle Time / sum of I:E parts
When given a case on the exam with a ventilated patient. PaCO₂ is normal. Hypoxemia is present. PEEP and FIO₂ are high.

Which ventilator control should you use to increase PaO₂?
Ti

This allows for a longer period of oxygen diffusion across the alveolar-capillary membrane.
What is the most common ventilator control used to correct an inverse I:E ratio?

a. Flow
b. Rate (f)
c. VT
d. Sensitivity
a. Flow
The sensitivity control should be set such that the patient is able to generate:

a. -0.2 to -0.5 cmH₂O
b. -0.5 to -1.0 cmH₂O
c. -1.0 to -1.5 cmH₂O
d. -0.5 to -1.5 cmH₂O
e. -0.5 to -2.0 cmH₂O
e. -0.5 to -2.0 cmH₂O
Give the sigh rate and volume settings for a ventilator.
Sigh Rate: 6-12 sighs/hour
Sigh Volume: 1.5 - 2.0 times the VT
Expiratory retard causes an increase in intrathoracic and mean Paw pressures. This may result in what?
Reduced Venous Return
Reduced Cardiac Output
What is the optimal level of PEEP indicated by?
1. Best Lung Compliance (Static)
2. Best PṽO₂ value
3. LIP and UIP on a pressure/volume curve
4. Highest Cstat

*Highest Cstat is best indicator without decreasing QT.
The PIP level should be maintained at _______ to prevent lung tissue damage.
35-40 cmH₂O
A PaCO₂ greater than ________ indicates ventilatory failure.
50 mmHg
What two measurements are important when dealing with a patient with possible Guillain-Barré syndrome?
1. MIP
2. VC
Give the parameters for the initiation of mechanical ventilation for:

VC
P(A-a)O₂
VD/VT
MIP
Respiratory Rate (f)
VC < 10-15 mL/kg

P(A-a)O₂ > 450 mmHg with 100% O₂

VD/VT > 60%

MIP > -20 cmH₂O

Respiratory Rate (f) > 35 bpm
How does a tracheostomy affect VD?
A tracheostomy decreases anatomic VD.
For every 100 mL of dead space added to the circuite, PaCO₂ increases by:

a. 20 mmHg
b. 15 mmHg
c. 10 mmHg
d. 5 mmHg
e. none of the above
d. 5 mmHg
How is physiologic dead space calculated?
Anatomic VD + Alveolar VD = Physiologic VD
Which ventilator modes would you never add mechanical dead space to? Why?
SIMV, PSV, CPAP

These are modes where the patient breaths spontaneously. Dead space would increase Raw and WOB in this modes.
The longer the time of positive pressure in the airways, the more impedance of blood flow from the head. This increases _________.
The longer the time of positive pressure in the airways, the more impedance of blood flow from the head. This increases ICP.
When dealing with ventilated patients with head trauma, the clinician wants to maintain PaCO₂ between ____________. Why?
When dealing with ventilated patients with head trauma, the clinician wants to maintain PaCO₂ between 25-30 mmHg.

CO₂ is a vasoconstrictor. High levels constrict the blood vessels of the brain, increasing ICP.
When dealing with ventilated patients with head trauma, how would the clinician control PaCO₂ on the ventilator. Why?
Using Rate.

Increasing VT or pressure might increase intrathoracic pressure, obstructing venous blood flow from the upper body and increasing ICP.
There are three types of oscillating ventilators. Name them.
1. Piston
2. Diaphragm
3. Flow interrupter
How does a clinician lower the PaCO₂ on a HFO ventilator?
↑ frequency or the amplitude
For the board exam, a clinician should begin weaning PEEP when FIO₂ is _________.
60% or less
This type of flow pattern is beneficial to patients with increased respiratory rates.

a. square wave
b. sine wave
c. decelerating wave
d. accelerating wave
a. square wave
This flow pattern benefits patients with increased Raw because airway turbulence produced by this flow is decreased.

a. square wave
b. sine wave
c. decelerating wave
d. accelerating wave
b. sine wave
This pattern benefits patients with low compliance by allowing ventilation to occur at a decreased pressure.

a. square wave
b. sine wave
c. decelerating wave
d. accelerating wave
c. decelerating wave
This flow usually results in optimal distribution of gas, lower PIP, reduced WOB and improved patient comfort.

a. square wave
b. sine wave
c. decelerating wave
d. accelerating wave
c. decelerating wave
This pattern creates turbulence of flow in the beginning of inspiration; therefore, more volume may be delivered through narrowed or obstructed airways.

a. square wave
b. sine wave
c. decelerating wave
d. accelerating wave
d. accelerating wave
The difference between peak pressure and plateau pressure is_______.
Raw
Peak pressure rises during inspiration and is determined by:

1. Flow
2. VT
3. Raw
4. Cstat
5. Cdyn

a. 1, 2, 3
b. 2, 3, 4
c. 2, 3, 4, 5
d. 1, 2, 3, 4, 5
e. 1, 4, 5
d. 1, 2, 3, 4, 5

All of them.
What ventilator adjustments would you make knowing the following ABGs:

↓ pH
↑ PaCO₂

↓→ PaO₂
↑ VT (to maintain 8-12 mL/kg)
↑ Rate
What ventilator adjustments would you make knowing the following ABGs:

↑ pH
↓ PaCO₂

↑→ PaO₂
↓ VT
↓ Rate

Add Mechanical dead space
What ventilator adjustments would you make knowing the following ABGs:

→ pH
↑ PaCO₂
↑ HCO₃

PaO₂ of 50-65 mmHg
No adjustment needed.

This is a patient with COPD. May consider weaning.
What ventilator adjustments would you make knowing the following ABGs:

↑→ pH
↓→ PaCO₂

↓ PaO₂
↑ FIO₂ if < 60%

Add or ↑ PEEP if FIO₂ > 60%
What ventilator adjustments would you make knowing the following ABGs:

→ pH
→ PaCO₂

↑ PaO₂
↓ FIO₂ if > 60%

↓ PEEP if FIO₂ ≤ 60%
What ventilator adjustments would you make knowing the following ABGs:

↓ pH
→ PaCO₂
↓ HCO₃
No ventilator changes are necessary: administer HCO₃
Pressure control ventilation is most commonly used for adults with what lung condition?
ARDS
What effect does decreasing lung compliance have on delivered VT in a neonate receiving pressure-limited ventilation?
↓ VT
What level of pressure support should be used for weaning so that airway resistance is overcome while breathing is spontaneous?
5-10
As the oxygenation status of a patient worsens while using an O₂ mask, at what point should CPAP be employed?
If 60% O₂ still results in hypoxemia (and PaCO₂ is normal or low)
Calculate the ventilator tubing compliance when the volume is set at 200 mL (0.2 L) and an inspiratory pressure of 50 cmH₂O is generated.
4 mL/cmH₂O

200/50 = 4
On the initial ventilator setup, at what range should the ventilator rate be set?
8-12 /min
How should the appropriate ventilator VT be determined?
10-12 mL/kg
List six indications for the use of PEEP.
1. atelectasis
2. hypoxemia with the use of 60% O₂
3. ↓ FRC
4. ↓ lung compliance
5. pulmonary edema
List four hazards of PEEP.
barotrauma
↓ venous return
↓ QT
↓ urinary output
Define optimal PEEP.
The level of PEEP that improves lung compliance without decreasing QT.
After the PEEP level is increased, how can it be determined that cardiac output has been adversely affected?
Decreasing PṽO₂ levels and a drop in blood pressure.
How may the ventilator low-pressure alarm be activated?
leaks in the circuit
patient disconnection
List ways that the ventilator high-pressure alarm may be activated.
↓ lung compliance
airway secretions
bronchospasm
water in vent tubing
kink in vent tubing
coughing
How should the high-pressure alarm be set?
5-15 cmH₂O above PIP
List some factors that affect airway resistance (Raw).
bronchospasm
water in tubing
mucosal edema
secretions
What is normal PETCO₂?
35-45 mmHg or 4.5-5.5%
List four conditions that result in a decreased PETCO₂ reading.
hyperventilation
apnea
total airway obstruction
hypotension
pulmonary embolism
↓ QT
List two conditions that result in an increased PETCO₂ reading.
hypoventilation
hyperthermia
List six criteria that indicate mechanical ventilatory assistance is necessary.
1. VC < 15 mL/kg
2. P(A-a)O₂ > 450 mmHg with 100% O₂
3. VD/VT > 60%
4. MIP > -20 cmH₂O
5. PEP < 40 cmH₂O
6. RR > 35
Calculate the static lung compliance if the VT is 750 mL, PIP is 46 cmH₂O, PEEP is 8 cmH₂O, and plateau pressure is 28 cmH₂O.
37.5 mL/cmH₂O

750 / 20 = 37.5
What is indicated if peak inspiratory pressures are increasing but the plateau pressure is not increasing?
Raw is increasing
What respiratory rates are used with HFJV?
100-600 cycles/min
List our advantages of HFV ver conventional ventilation.
1. reduced risk of barotrauma
2. reduced risk of cardiac side effects
3. less fluctuation in ICP
4. muco-ciliary clearance improvement
A ventilator patient receiving an FiO₂ of 0.30 has a PaO₂ of 60 mmHg.

To increase the PaO₂ to 80 mmHg, what change to the FiO₂ must be made?
Increase FiO₂ to 40

80 x 0.3 = 0.40
A patient using the ventilator in the control mode with a ventilator rate of 8/min has a PaCO₂ of 55 mmHg.

To decrease the PaCO₂ to 40 mmHg, what change must be made to the ventilator rate?
Increase ventilator rate to 11/min

[8 x 55] / 40 = 11
A 36 year-old woman uses a ventilator in A/C with the following variables: rate 10/min, VT 650 mL, and FiO₂ 0.40.

ABG results: pH 7.27, PaCO₂ 54, PaO₂ 75, HCO₃ 26

What ventilator change should be made?
Increase the VT or rate to decrease PaCO₂
A ventilator patient receiving an FiO₂ of 0.70 and PEEP of 8 has a PaO₂ of 147.

What ventilator adjustment should be made to reduce the PaO₂?
Decrease the FiO₂ to 0.60
On a volume waveform, if the tracing does not return to baseline, what does this indicate?
leaks in the tubing or around the ET tube or chest tube; air trapping
Using 4 mL/cmH₂O for compliance, calculate the corrected VT when the patient is receiving a VT of 700 mL with a PIP of 20 cmH₂O.
620 mL

lost volume = PIP x tubing compliance

20 x 4 = 80
700-80 = 620 mL