Blood Gas Sampling, Analysis, Monitoring, and Interpretation CRT 7% RRT 6%

Mechanical ventilation End tidal CO2 monitoring Shunt assessment The respiratory therapist has just completed an uneventful bronchodilator treatment for a male patient admitted to the hospital after collapsing during a marathon race. The patient suddenly complains of difficulty breathing and chest pain. His heart rate increases from 70 to 115 bpm and he is tachypneic. To further evaluate this patient the therapist should immediately institute: Mechanical ventilation End tidal CO2 monitoring Shunt assessment CPAP therapy at 100% Answer B

Which of the following should the respiratory therapist recommend? A 38-week gestation neonate has the following capillary blood gas results: pH 7.34 PCO2 47 torr PO2 43 torr HCO3- 24mEq/L Which of the following should the respiratory therapist recommend? An oxyhood with 50% oxygen Mechanical ventilation CPAP with nasal prongs at 5 cmH2O No therapy is indicated at this time Answer C

Based on these results the respiratory therapist should recommend: An arterial blood gas was drawn in the surgical intensive care unit and the syringe was left on the counter for the lab tech to take to the lab. Forty minutes later, the results are recorded as follows?: pH 7.48 PaCO2 24 torr PaO2 100 torr HCO3- 25 mEq/L Based on these results the respiratory therapist should recommend: Institute mechanical ventilation Begin bi-level ventilation at an IPAP of 20 cmH2O and EPAP of 8 CmH2O Repeat the arterial blood gas Recalibration of the blood gas machine Answer C

The following data is available on a recently admitted patient: HR 88/min RR 18 bpm SaO2 91% A-a gradient 175 torr BS coarse rales BP 137/88 Based on this information the respiratory therapist should suggest: Oxygen therapy Mechanical ventilation Noninvasive PPV Nothing until more information is obtained Answer A

Which PEEP level provides optimum benefit for this patient? 10 cmH2O During pulmonary rounds in the intensive care unit, the respiratory therapist decides to perform an optimal PEEP study on a patient. The following data is recorded: Which PEEP level provides optimum benefit for this patient? 10 cmH2O 15 cmH2O 20 cmH2O 25 cmH2O PEEP level PaO2 C(a-v)O2 HR 0900 10 cmH2O 70 torr 5 cmH2O 88 bpm 0930 15 cmH2O 85 torr 78 bpm 1000 20 cmH2O 93 torr 7 cmH2O 89 bpm 1030 25 cmH2O 100 torr 95 bpm Answer B

To increase a low PaO2 Increase FiO2 by 5-10% (up to 60%) Increase PEEP by 2-5 cmH2O Until: Acceptable oxygenation is achieved, or Unacceptable side-effects occur ↓ compliance ↓ cardiac function Barotrauma ↑ C(a-v)O2 Closed head injury or low BP: Increase FiO2 instead of PEEP. Keep pressures low!

Maintain current settings Administration of bicarbonate A 30-year-old-male patient is receiving volume control ventilation due to complications of a surgical procedure to drain a lung abscess. The patient weighs 98 kg (215 lb) and is 6 feet (185 cm) tall. His ventilator settings are: SIMV mode, Vt 830 mL, set f 14 bpm, total f 15 bpm, FiO2 0.4. Arterial blood gases drawn after thirty minutes show the following: pH 7.46 PaCO2 32 torr PaO2 90 torr HCO3- 21 mEq/L Which of the following should the respiratory therapist recommend at this time? Maintain current settings Administration of bicarbonate Add mechanical dead space Decrease frequency Answer D

To normalize a low PaCO2 Decrease respiratory rate Decrease tidal volume Increase deadspace Target PaCO2 for closed head injury patients should be 25-30 torr

Which of the following should the respiratory therapist recommend? A 74 kg (163 lb) male patient has been on volume control ventilation for the past four days at the following settings: A/C mode, Vt 700 mL, set f 10 bpm, total f 10 bpm, FiO2 0.6. The most recent arterial blood gas data is recorded as follows: pH 7.34 PaO2 61 torr PaCO2 52 torr HCO3- 28 mEq/L Which of the following should the respiratory therapist recommend? Increase frequency to 14 bpm Switch to SIMV mode Increase FiO2 0.65 Add 5 cmH2O of pressure support 1 and 4 2, 3, and 4 1 and 3 2 and 4 Answer C

To normalize a high PaCO2 Decrease or remove deadspace Increase tidal volume Increase the respiratory rate

Which of the following should the respiratory therapist recommend? A 24-year-old male patient is in the Emergency Department after being involved in a motor cycle accident. It is estimated the patient is 5 foot 10 inches (178 cm) tall and weighs 80 kg (176 lb). After a quick bedside assessment the patient is intubated and placed on volume control ventilation at the following settings: SIMV mode, f 10 bpm, Vt 770 mL, FiO2 0.6, PEEP 10 cmH2O. After twenty minutes his arterial blood gas shows the following results: pH 7.39 PaO2 51 torr PaCO2 36 torr HCO3- 24 mEq/L Which of the following should the respiratory therapist recommend? Increase tidal volume to 800 mL Switch to assist control mode Increase the FiO2 to 0.7 Increase PEEP to 15 cmH2O Answer D

After reviewing the data the respiratory therapist should recommend: A 65 kg (143 lb) female patient is in the surgical intensive care unit after surgery to relieve a sub-arachnoid hemorrhage. She is on volume cycled ventilation at the following settings: A/C mode, set f 12 bpm, total f 12 bpm, Vt 800 mL, FiO2 0.4. Available arterial blood gas information is recorded as: pH 7.34 PaO2 85 torr PaCO2 46 torr HCO3- 22 mEq/L After reviewing the data the respiratory therapist should recommend: Increase the tidal volume Increase the frequency Add PEEP Add mechanical dead space Answer B

While performing quality control procedures on a blood gas machine, it is determined that the PCO2 electrode has a mean value of 32 torr. The next three control run values are recorded as 31 torr, 37 torr, and 34 torr. Which of the following would best explain these results? In control Out of control Random error Displaying a trend Answer C