RRT Management Flashcards: 220 Practice Questions & Answers

The NBRC and CDC guidelines specify a Head of Bed (HOB) elevation of 30-45 degrees. Rational: This position uses gravity to prevent the aspiration of gastric contents and oropharyngeal secretions into the lower airway. Exam Strategy: NBRC often tests this as the first-line, lowest-cost intervention for VAP prevention. If a patient must be flat for a procedure, the RT must ensure it is returned to 30-45 degrees immediately afterward.

Absolute contraindications for NIV include: 1. Cardiac or respiratory arrest 2. Inability to protect the airway (aspiration risk) 3. Excessive secretions 4. Facial trauma or burns preventing a mask seal 5. Hemodynamic instability (shock) 6. Uncooperative/agitated patient. Exam Note: NBRC often tests the vomiting scenario. If a patient is actively vomiting, NIV is contraindicated due to the high risk of aspiration. In such cases, move directly to endotracheal intubation.

Start PEEP at ~20-25 cmH2O and decrease by 2 cmH2O every 3 minutes while monitoring static compliance (Cstat). Optimal PEEP is the level that provides the highest Cstat or the level 2 cmH2O above where compliance significantly drops (the closing pressure). NBRC emphasizes choosing PEEP that balances oxygenation and recruitment without causing overdistension (which would decrease compliance).

A unilateral loss of chest wiggle is a hallmark sign of a pneumothorax or a complete mainstem bronchial obstruction (mucous plug). Rationale: Because HFOV relies on high-frequency oscillations, the wiggle should be symmetrical from the clavicles to the mid-thigh. A sudden change in chest wall vibration indicates an acute change in the transmission of these oscillations through the lung tissue or pleural space. Next Step: Immediate auscultation and chest X-ray; consider needle decompression if hemodynamically unstable.

Dose: 0.01 to 0.03 mg/kg of the 1:10,000 (0.1 mg/mL) concentration. Clinical Procedure: Follow the IV bolus with a 0.5 to 1.0 mL normal saline flush. Note: If IV access is not yet established, an endotracheal (ET) dose may be given once (0.05 to 0.1 mg/kg), but IV/IO is the preferred route due to more predictable absorption. NBRC Focus: Know the concentration (1:10,000) and the IV dose range. If the question asks for the most effective route, choose IV or IO over ET.