EMOVA Post Course Test

A 45-year-old man is in cardiac arrest at the local shopping mall.  Advanced cardiac life support resuscitation has been taking place for 8 minutes, including the placement of an endotracheal tube with end-tidal carbon dioxide (ETCO2) monitoring.  During compressions a reading of 15mmHg is noted which increases to 55mmHg when compressors are rotated. 

Which of the following is the most likely explanation for the increased ETCO2 reading?

A 77-year-old man who is a resident at a retirement village is complaining of difficulty breathing.  The nurses at the retirement village clinic say that his condition has deteriorated over the last 6 hours.  He was diagnosed with heart failure 3 years ago for which he takes Captopril ® (ACE inhibitor), Coreg® (beta-blocker) and Lasix® (diuretic).  Physical examination shows that he is still alert, has a respiratory rate of 30 breaths per minute, heart rate of 98 beats per minute, blood pressure of 102/68mmHg, saturation of 90% on room air, use of accessory muscles and coarse crackles on chest auscultation. The patient is still awake and cooperative but appears confused. He has not been able to eat or drink for the last few hours due to his respiratory distress.

Which of the following is the most appropriate immediate intervention?

You are treating an adult patient who is presenting with an acute asthma attack. The vital signs are as follows:

Patient is breathless while at rest and appears to be agitated. The patient is using accessory muscles to breathe at a rate of 25b/min, and you note a loud expiratory wheeze throughout exhalation. There is evidence of pulses paradoxus of 15mmHg, and peak flow meter is reading at 65% of the expected range for the patient according to weight and height. The SPO2 is at 92%

What severity of asthma is the patient presenting with?

A patient presents to you with severe respiratory distress following an asthma attack. The patient has been intubated and is now ventilated. The doctor who takes over your patient asks if you noted any “auto-peep” during your management of the patient. Which option below best describes the phenomenon of auto-peep?

You have just decided to intubate a patient who presented with a flail chest and severe respiratory distress. You administered the following medications and doses: Succinycholine at 2mg/kg and Ketamine and 2mg/kg. You notice that after the ETT is in place, the patient begins to spasm, he clamps down hard on the ETT with his teeth and feels very warm to touch. The ETCO2 alarm alerts you to the increasing levels (over 50mmHg) and the patient has a heart rate well above his initial with what appear to be widening QRS complexes. What is the most likely diagnosis for this patient’s condition?

30 minutes into a transfer, with no adverse events as yet, the ventilator starts alarming with high-pressure alarms and the patient’s respiratory rate is noted to be increased, air entry is clear bilaterally. What could be done to correct this problem?

The ideal tidal volume for a mechanically ventilated patient who weighs 90kg is…

While treating a 70kg patient who was involved in a car accident where the patient hit the steering wheel with his chest, and there was no airbag. The patient is being ventilated with a mechanical ventilator on route to the hospital. Suddenly the patient is noted to drop SPO2 from 98% to 88%, you note the inspiratory pressure has not increased, the FiO2 is still maintained at 1.0 and the ventilator is not alarming. Ventilator settings are as follows: TV: 420ml, RR: 12b/min, pressure support 10cmH₂0, and PEEP 5cmH₂0.

What is the best way to assist this patient with their oxygenation status?

The vocal folds chanage position by the movement of which cartilage?

You are assisting a patient who has been admitted to the medical ward for respiratory distress. She is a 70 year old female who has been seen in the facility in the last 4 years, she has been battling breast cancer. In the last few weeks the patient has become progressively less mobile and has lost a lot of weight. She is no longer receiving chemotherapy management. The family plan was for the patient to pass away peacefully at home in the care of her daughter, but her daughter became really distressed as the patient presented with severe distress at home. Concerned that she was not helping her mom appropriately at home. The patient appears to be gasping for air, is minimally conscious, and is breathing at a rate of 34b/min. She is using accessory muscles to breathe and looks incredibly uncomfortable. Which medication would be the first line for management of this patient’s dyspnoea.

You are assisting a patient who was involved in a pedestrian vehicle accident about 60 minutes ago. The patient is a well-developed 34 year old male patient, complaining of severe chest pain and shortness of breath. He has SPO₂ of 90% on room air, a respiratory rate of 45b/min, blood pressure of 130/80mmHg. He presents with a significant defect to the left side of the chest, along with paradoxical chest wall movement, he is breathing with shallow respirations.

Which of the following is the best initial (first line) approach to the management of this patient.

Which of the following may predict difficult bag-valve-mask ventilation?

High levels of ETC0₂ can be rectified (in the long term) by changing all but one of the following, which one

For the scenario below, you must choose the best description of the acid/base disorder, as well as the best options for management of the patient. This question may be worth multiple points.

A 34 year old male patient post cardiac arrest. The  patient is intubated with a size 7.5 cuffed ETT and is being ventilated at 1b/6 seconds by the BLS crew member on the way hospital, PEEP valve in place and set to 7cmH₂0. On arrival the blood gas and vitals are as follows:

pH:                          7.12

PaCO2:                   67mmHg

PaO2:                     98mmHg

HCO3:                    18mEq/l

Lactate:                  4.9mmol/l

For the scenario below, you must choose the best description of the acid/base disorder, as well as the best options for management of the patient. This question may be worth multiple points.

A 29 year female patient who overdosed on tricyclic antidepressants, presents with no respiratory effort and was intubated on scene, patient is being ventilated at 14b/min with BVM but the oxygen cylinder on the ambulance is empty. The patient arrives at ED with the following blood gas and vital signs:

pH:                          6.8

PaCO2:                   28mmHg

PaO2:                     67mmHg

HCO3:                    12mEq/l

Lactate:                  3.2mmol/l

Vital signs: HR: 101b/min wide QRS complex’s, SPO2:90%, BP: 98/58mmHg, GCS:3/15, no spontaneous rate of ventilation.

For the question below, pick the best description of the acid/base abnormality, and the best options for management of the patient (there may be more than one correct option)

You are dispatched to transfer a patient from an outlying hospital after intubation for a respiratory arrest (the patient has pulmonary oedema and heart failure). On arrival the blood gas reveals the following:

pH:                                  7.65

PaCO2:                           22mmHg

PaO2:                             74mmhg               

HCO3:                            24mEq/l

 The patient is on a FiO2 of 1.0, peak inspiratory pressure of 24cmH2O, PEEP of 5cmH20, tidal volume 500ml.

Vital signs: HR: 124b/min, SPO2: 88%, BP: 156/86mmHg, respiratory rate 48b/min, GCS 8/10(T), pressure alarms noted on ventilator (high pressure), he  weighs 80kg.

A 38 year male patient with an acute severe, life-threatening asthma attack presents with resistance on BVM ventilation, he is breathing spontaneously at a rate of 38b/min and is working hard to breathe. He has a PaCO2 reading of 68mmHg, and ongoing bronchoconstriction.

You have opted to place the patient on a ventilator, which of the following options are the most appropriate method of control for ventilation for this patient?

The expected ETCO2 and PaCO2 levels in a patient in cardiac arrest (pulseless) are as follows:

i.       ETCO2 will be higher than normal

ii.      ETCO2 will be lower than normal

iii.      PaCO2 will be higher than normal

iv.      PaCO2 will be lower than normal

For the following, select the options that are correct:

Regarding the oxygen haemoglobin dissociation curve:

i.        The lower part of the curve is steeper, which favours offloading of oxygen in peripheral tissues with only small falls in capillary PO₂

ii.       A right-shift of the curve, caused by a decrease in temperature, assists in further off-loading of oxygen

iii.      A left-shift of the curve favours affinity of haemoglobin for oxygen

iv.      Increased 2, 3 DPG promotes offloading of oxygen from haemoglobin to the tissues

Select the conditions most likely to benefit from VV ECMO in patients with acute respiratory failure refractory to first and second line treatments:

With regard to airway assessment and management:

i.         The one of the “M”’s in MMAP stands for “measurements” 

ii.       The jaw thrust is NOT recommended anymore as it is too difficult for many practitioners to perform           

iii.      The Mallampati score is the most accurate indicator of the potential ability to place an ETT into the airway

iv.      The fact that a patient is unresponsive to stimuli means that there will not be a gag reflex present

For the ETCO2 tracing below, select the option/options that best explain the tracing found.

For the ETCO2 tracing below, select the option/options that best explain the tracing found.

For the ETCO2 tracing below, select the option/options that best explain the tracing found.

For the ETCO2 tracing below, select the option/options that best explain the tracing found.

For the ETCO2 tracing below, select the option/options that best explain the tracing found.

You have decided to intubate a 60-year old patient with chronic renal failure (who missed his last dialysis appointment), with ventilation and oxygenation as the indication. He is in severe respiratory distress and after a trial of NIV, he seems to be deteriorating. The patient presents with the following vital signs: BP: 92/50mmHg, HR: 67b/min with borderline wide QRS complex, he has an SPO₂ reading of 89% on NIV and ETCO₂ of 54mmHg. The blood gas machine is not working today. Which induction agent and dose would be first line for this patient? 

A 34 year old patient presents to the ED with EMS, the patient has a history of epilepsy with frequent seizures and multiple admissions to ICU for status epilepticus. EMS have administered max dose Lorazepam on route, with no effect on the seizures,it is estimated the seizures have lasted approximately 20 minutes. The patient has started vomiting and the risk of aspiration is high. You decide to intubate the patient. The patient has the following ABG on admission: pH 7.2, PaCO₂ 72mmHg, PaO₂ 58mmHg, K⁺: 4.4mmol/l, there is no evidence of trauma to the patient. BP is 100/60mmHg. You have no access to reversal agents in the facility.

Which paralytic agent would be the best (first-line) for this patient, and what is the correct dose? 

A 24 year old trauma patient has arrived in the unit, he is immobilized on a spine board, the patient has an obviously fractured pelvis, as well as bilateral femur fractures. He presents with decreased GCS, is snoring despite a jaw thrust, and has decreased oxygen saturation readings. His vitals are as follows: HR 135b/min narrow complex rhythm, RR 18b/min with clear air entry bilaterally, SPO2 88% on polymask, ETCO2: 18mmHg, BP 85/50mmHg.

Choose the most correct statements regarding the choice and dose of induction agent as well as paralytic agent you would use for intubation of this patient.

Which of the following Pressure/Time graphs on a ventilator could be linked to an asthma patient presenting with air-trapping and auto-peep?

For the questions below, choose the answers that are CORRECT

With regard to SPO2

Select only the CORRECT statements below 

With regard to head injured patients with raised intracranial pressure:

Select only the options that are CORRECT

Select only the option that are CORRECT

With regard to the ventilation and management of the patient who has been submerged in water

Select only the options that are CORRECT

The ventilator has a number of modes and settings

Obtaining and acting on arterial blood gases is an important step in diagnosing and treatment of critically ill patients. Which statements regarding blood gases are true?

Select the CORRECT answers with respect to oxygen