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
... [Show More] 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 necessary - this is used to exchange tubes already in place.
A 5'6" female has been transferred from Intermediate Care to Intensive Care in respiratory distress. She
is intubated with a silver-coated #7.0 Endotracheal tube. CXR immediately following intubation shows
Right Upper Lobe infiltrate with bibasilar atelectasis. The ET Tube is noted to be approximately 4 cm
above the carina.
The Respiratory Therapist would BEST recommend:
A) Initiation of broad-spectrum antibiotics for probably pneumonia
B)Withdraw Endotracheal tube at least 3 cm
C) Use tube exchanger to replace Endotracheal tube from silver-coated to a low-pressure/high-volume
cuffed tube
D) Immediate V/Q Scan - ✔✔Correct answer is A
This pt has gone into respiratory failure, requiring intubation. The X-ray is consistent with a possible
pneumonia diagnosis. The best option therefore is to start antibiotics.
Withdrawing ET Tube is not indicated as 4 cm is likely adequate. Pulling back 3 cm could result in
inadvertent extubation and would cause harm to patient
Use of tube exchanger is unnecessary. A silver-coated endotracheal tube is intended to help prevent
VAP
Immediate V/Q scan is not indicated - it is a poor use of resources for what is needed right away.
You are part of Physician Rounding this morning, and consulting on a patient who is currently on APRV.
They were originally admitted with a pneumonia which developed into ARDS with a P/F ratio as low as
110. The patient was transitioned to APRV from PC due to an elevated Plateau Pressure required to
maintain VT around 4 cc/kg IBW. The patient is arousable and taking breaths on their own. The physician
has asked you what should be done to address the patient's latest ABG.
Ph 7.16
PaCo2 49
PaO2 88 torr
HCO3 19
Mode- APRV
Phigh- 24
Plow- 0
Thigh- 5.0 sec
Tlow- o.5 sec
PS- 26
FiO2- 80% [Show Less]