Free RRT-ACCS Exam Flashcards

A bougie is a flexible introducer passed into the trachea when the glottis is poorly visualized; the endotracheal tube is then railroaded over it. It is a first-line rescue for anticipated or encountered difficult laryngoscopy.

Video laryngoscopy uses a camera at the blade tip to improve glottic visualization, often achieving a better view than direct laryngoscopy in patients with limited mouth opening or anterior airways, improving first-pass success.

Cricoid pressure (Sellick maneuver) compresses the esophagus against the cervical spine to reduce passive regurgitation and aspiration risk during rapid sequence intubation; it should be released if it worsens the laryngeal view.

The Mallampati class (I-IV) is a bedside score based on visible oropharyngeal structures with the mouth open and tongue protruded; higher classes (III-IV) predict a more difficult direct laryngoscopy and intubation.

It has a separate lumen opening above the cuff that allows aspiration of secretions pooling on top of the cuff, reducing microaspiration into the lower airway and lowering ventilator-associated pneumonia (VAP) risk.

A double-lumen tube isolates the two mainstem bronchi to allow independent lung ventilation or one-lung ventilation, used for unilateral lung pathology such as massive hemoptysis or bronchopleural fistula.

It is a long, hollow, semi-rigid catheter placed through an existing endotracheal tube before removal, allowing oxygenation and a guided, lower-risk exchange to a new tube if reintubation becomes necessary.

A T-piece (T-tube) trial delivers humidified gas to a capped-open tracheostomy without ventilator support, used as a weaning/liberation step to assess readiness for decannulation once ventilator weaning is complete.

6 mL/kg of predicted body weight (PBW), calculated from height and sex rather than actual body weight, per the ARDSNet protocol, to limit volutrauma while keeping plateau pressure at or below 30 cmH2O.

Plateau pressure (Pplat), measured during an inspiratory hold, should be kept at 30 cmH2O or less to limit alveolar overdistension; tidal volume is reduced further toward 4 mL/kg PBW if Pplat exceeds this limit.

Driving pressure equals plateau pressure minus PEEP (Pplat - PEEP), reflecting the pressure actually stretching the lung per breath; keeping driving pressure below 15 cmH2O is associated with lower ARDS mortality.

P/F ratio equals PaO2 divided by FiO2 (FiO2 as a decimal). It quantifies the severity of hypoxemia independent of the oxygen percentage delivered and is the core criterion of the Berlin ARDS definition.

With PEEP/CPAP of 5 cmH2O or more: mild ARDS is P/F 200-300, moderate is P/F 100-200, and severe is P/F below 100. Onset must be within 1 week of a known insult with bilateral opacities not fully explained by effusion or cardiac failure.

Permissive hypercapnia tolerates a higher-than-normal PaCO2 and lower pH as a trade-off for using lower tidal volumes and plateau pressures in ARDS, protecting the lung as long as the acidosis remains hemodynamically tolerated.

The ARDSNet PEEP/FiO2 table pairs a target FiO2 with a corresponding PEEP level to standardize oxygenation strategy; a recruitment maneuver applies a sustained higher airway pressure briefly to reopen collapsed alveoli before setting maintenance PEEP.

If increasing PEEP raises plateau pressure while compliance falls, the lung is being overdistended and PEEP should be reduced; if compliance improves or holds steady as PEEP rises, the higher PEEP is likely recruiting collapsed alveoli.

Per the PROSEVA protocol, prone positioning is used for a P/F ratio below 150 on FiO2 of 0.6 or higher with PEEP of 5 cmH2O or more; sessions are sustained for at least 16 hours per day to improve V/Q matching and oxygenation.

Facial and airway edema, pressure injuries at the face/chest/knees, and accidental line or tube dislodgement during turning are the main complications; careful padding and a coordinated turn team reduce risk.

VV ECMO provides respiratory support only (oxygenation and CO2 removal) for refractory hypoxemic or hypercapnic respiratory failure without native cardiac support; VA ECMO adds circulatory support for refractory cardiogenic shock or combined cardiopulmonary failure.

ELSO guidance supports ECMO consideration for a P/F ratio below 80, a Murray lung injury score greater than 3, or a pH below 7.25 with an elevated PaCO2 despite optimized conventional mechanical ventilation.

RSBI equals respiratory rate in breaths per minute divided by tidal volume in liters, measured during brief unsupported breathing. An RSBI below 105 predicts a higher likelihood of successful weaning or extubation.

Stable oxygenation and hemodynamics during the SBT, plus adequate cough strength, secretion burden, and mentation to protect the airway; a positive cuff-leak test also lowers concern for post-extubation stridor before removing the tube.

Static compliance equals tidal volume divided by (plateau pressure minus PEEP). It reflects lung and chest-wall stiffness; a falling static compliance in ARDS signals worsening lung stiffness or overdistension.

The A-a gradient (PAO2 minus PaO2) estimates how much oxygen transfer is impaired by shunt, V/Q mismatch, or diffusion defect rather than hypoventilation; normal is roughly 5-10 mmHg on room air and widens with age and worsening gas-exchange disease.

iNO is a selective pulmonary vasodilator that improves V/Q matching and reduces pulmonary vascular resistance in refractory hypoxemia or pulmonary hypertension; its key complication is methemoglobinemia, which requires monitoring during prolonged use.

Heliox, a helium-oxygen mixture, is indicated for upper airway obstruction such as post-extubation stridor or severe asthma because its lower density reduces turbulent airflow resistance, decreasing the work of breathing.

Aerosolized or instilled tranexamic acid (TXA) and epinephrine control airway bleeding; aerosolized heparin reduces mucus plugging; aerosolized antimicrobials target resistant airway pathogens; instilled lidocaine provides topical airway anesthesia.

Central venous pressure (CVP, normal 2-8 mmHg) estimates right atrial/right heart preload, while pulmonary capillary wedge pressure (PCWP, normal 6-12 mmHg) estimates left atrial preload; PCWP requires a pulmonary artery catheter and better reflects left-sided filling.

Normal cardiac index is 2.5-4 L/min/m2 and normal SVR is 800-1200 dynes-sec/cm5. Preload is the volume stretching the ventricle before contraction; afterload is the resistance the ventricle must overcome during ejection.

The ROX index (SpO2/FiO2 divided by respiratory rate) predicts the risk of HFNC failure requiring escalation to noninvasive or invasive ventilation; a lower ROX index signals higher failure risk and warrants closer monitoring.

IAH is sustained intra-abdominal pressure above 12 mmHg; abdominal compartment syndrome is intra-abdominal pressure above 20 mmHg with new organ dysfunction, which can impair diaphragmatic excursion and ventilation.

TTM targets a controlled temperature of 32-36 degrees C for a defined period after arrest to reduce secondary neurologic injury, followed by careful, controlled rewarming and fever avoidance.

A rising serum creatinine paired with falling urine output signals AKI, which can be driven by hypoperfusion, sepsis, nephrotoxins, or abdominal compartment syndrome and complicates fluid and drug dosing decisions.

Normal ABG values: pH 7.35-7.45, PaCO2 35-45 mmHg, HCO3 22-26 mEq/L. These values are interpreted together to classify respiratory versus metabolic acidosis or alkalosis and assess compensation.

Elevated lactate is a marker of tissue hypoperfusion and anaerobic metabolism, commonly from sepsis, shock, or severe respiratory failure; trending lactate clearance helps guide resuscitation adequacy.

HIT is suspected with a significant platelet count drop occurring days after heparin exposure, often with new thrombosis; a D-dimer helps rule out a clot when pretest probability is low, though it does not diagnose HIT itself.

Bilateral opacities on chest X-ray or CT that are not fully explained by effusion, lobar or lung collapse, or nodules, appearing within one week of a known clinical insult, are required alongside the P/F ratio and PEEP criteria.

Norepinephrine is the first-line vasopressor for septic shock per Surviving Sepsis Campaign guidance; dobutamine or milrinone are preferred inotropes for low-output cardiogenic shock to augment contractility without excessive vasoconstriction.

Sedatives such as propofol or dexmedetomidine should be titrated to a specific RASS target, often -2 to 0, using validated scales, paired with daily sedation interruption (SAT), to avoid oversedation that prolongs ventilation and delirium risk.

Continuous heparin requires monitoring of aPTT or anti-Xa levels for therapeutic dosing and platelet counts for early detection of heparin-induced thrombocytopenia, especially after several days of exposure.

Early enteral nutrition, started within about 24-48 hours of ICU admission, is preferred over parenteral nutrition when the gut is functional; gastric residual volumes are monitored without over-restricting feeds to reduce aspiration risk while avoiding underfeeding.

Within the first hour: measure lactate, obtain blood cultures before giving antibiotics, administer broad-spectrum antibiotics, give a 30 mL/kg crystalloid bolus for hypotension or lactate 4 or above, and start norepinephrine if the patient remains hypotensive.

Septic shock is sepsis with persistent hypotension requiring vasopressors to maintain a mean arterial pressure (MAP) of 65 mmHg or higher, plus a serum lactate above 2 mmol/L despite adequate fluid resuscitation.

Two separate clinical exams confirming absence of brainstem reflexes and cortical function, plus a formal apnea test showing no respiratory drive despite adequate CO2 stimulus, are required; ACCS content also embeds at least 5 ethics-related items, such as withdrawal-of-support and organ donation discussions, on every exam minipool.

START (Simple Triage and Rapid Treatment) rapidly sorts patients by respirations, perfusion, and mental status into immediate, delayed, minor, or deceased/expectant categories to allocate limited resources during a disaster.

The RT reports ventilator settings and trends, weaning progress, airway status, and gas-exchange data, and uses structured communication such as SBAR so the team can adjust the ventilation and sedation plan collaboratively each shift.

A mini-bronchoalveolar lavage passes a blind catheter through the endotracheal tube to sample distal airway secretions for quantitative culture, allowing VAP diagnosis at the bedside without a flexible bronchoscope.

The IABP inflates at the dicrotic notch, the start of diastole, to augment coronary perfusion, and deflates just before systole to reduce afterload; severe aortic insufficiency is a key contraindication because inflation worsens regurgitant flow.

ECMO circuit chatter, vibration in the drainage line, usually indicates inadequate venous return from hypovolemia or low preload, requiring volume or cannula repositioning; continuous-flow VADs produce a reduced or absent pulse pressure compared to native pulsatile cardiac output.

Units track adherence to VAP-prevention bundle elements such as head-of-bed elevation, daily SAT/SBT pairing, oral care, and subglottic suctioning as a process metric, and correlate compliance rates with VAP incidence to drive protocol updates.