ACCS Study guides, Class notes & Summaries

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 (2-3 dimensions) Cerebral angiography measures abnormal cerebral circulation PET scan checks for cancer, brain disorders and hea...

What is the thyromental distance? Measurement of the distance between the upper edge of the thyroid cartilage to the chin, while the neck is completely extended. Thyromental distance: what indicates a suspected difficult intubation? Less than 6 cm Thyromental distance: what suggests a non-problematic intubation? 7 cm or greater What type of x-ray should you use to determine proper position of an endotracheal tube? AP x-ray What type of x-ray is helpful in detecting pleural effusions?...

List the four critical life functions Ventilation - moving air in and out of the lungs Oxygen - getting oxygen into the blood Circulation - moving the blood through the body Perfusion - getting blood and oxygen into the tissue Which of the four life function is the FIRST priority? Ventilation HINT: Do not pick STAT ABG on the exam What assessments would determine how well a patient is ventilating? Respiratory Rate, tidal volume, chest movement, breath sounds, etco2, paco2 HI...

In difficult intubation, when traditional intubation with laryngoscope has failed and patient is starting to have low saturations, why is video laryngoscopy preferred over fiberoptic bronchoscopy to intubate? Fiberoptic bronchoscopy is an alternative method, but is technically difficult and requires specialized equipment Patient is on a ventilator with a chest tube in place. What is the cause of the low minute alarm and increased peak pressures (leak)? And what is your action to look for? Thi...

Normal Urine Output 40 mL/hr (approx. 1 Liter/day) Decreased CVP (<2 mmHg) Hypovolemia Increased CVP (>6 mmHg) Hypervolemia Glasgow Coma Scale (GCS) Eye-opening response Spontaneous opening- 4 To verbal stimuli- 3 To pain- 2 None- 1 Most appropriate verbal response Oriented- 5 Confused- 4 Inappropriate words- 3 Incoherent- 2 None- 1 Most intergrated motor response (arm) Obeys commands- 6 Localizes pain- 5 Withdraws from pain- 4 Flexion to pain- 3 Exte...

A difficult intubation is anticipated with an obese pt. The decision is made to intubate by video laryngoscopy. Which of the following is LEAST likely to be needed: A) Cook's Exchanger B) Rigid Stylet C) Cuffed Endotracheal Tube D) Video-enabled Laryngoscope A) cook's exchanger Video laryngoscopy involves use of a normal ET Tube with the addition of a rigid stylet, as well as a video-enabled laryngoscope and other normal intubation equipment. A Cook's Tube Exchanger is not neces...

Mallampati Scoring Score 1: full visualization of uvula, soft palate, tonsils, airway full open Score 2: may be able to visualize uvula, soft palate and upper portions of tonsils Score 3: soft and hard palate visible and base of vallecula. Issues when intubating Score 4: only the hard palate is visible --> difficult intubation Thyromental distance Determined by measurement of the thyroid cartilage to chin while neck is hyperextended 6.5 - 7 cm determines - non problematic/easy intubati...

Alveolar Oxygen Tension (PAO2)/Alveolar Air Equation Shortcut: (Fio2 x 7) -Paco2 +10 VD/VT and ratio Paco2-Peco2/Paco2 Make it a ratio by multiply answer by 100. 20-40% (up to 60% for vent pts) Alveolar Minute Ventilation (VT-VD) x f Anatomic deadspace 1ml per 1lb body weight Work of breathing change in Pressure X change in Volume .5-.7 J/L (.05-.07 kg-m/l) Alveolar-Arterial Oxygen Gradient (P(A-a)O2 or AaDo2 or A-a Gradient PAO2-PaO2 Normal:25-65 torr on 100% o2 V/Q mismatch: 66-...

The four critical life functions 1. Ventilation 2. Oxygenation 3. Circulation 4. Perfusion How is ventilation assessed RR, Vt, chest movement, breath sounds, ETCO2, PaCO2 How is oxygenation assessed HR, color, sensorium, SpO2, PaO2 How is circulation assessed HR and strength, cardiac output Perfusion BP, sensorium, temp, urine output, hemodynamics How to prioritize life functions during an emergency 1. Ventilation 2. Oxygenation 3. Circulation 4. Perfusion Of the life functi...

Three Types of Acute Respiratory Failure PaO2 < 50-60 torr on room air or PaO2/FIO2 ratio <300 Hypercapnic: PaCO2 > 50 torr Mixed Hypoxemic Respiratory Failure may be identified by PaO2 < 60 on RA SpO2 < 93% on RA PaO2/FIO2 ratio < 300 A-aDO2 > 200 Most common cause of Hypoxemic Respiatory failure ? V/Q mismatch Hypercapnic Respiratory Failure may be identified by? PaCO2 > 50 torr FVC <10mL/kg Maximal inspiratory pressure < -20cmH2O Clinical mani...