Permissive hypercapnia is needed to protect patients with ARDS ...

[burchfield96]

Permissive hypercapnia is needed to protect patients with ARDS from atelectrauma. Which of the following medications is appropriate to facilitate this?
 
  a. Propofol
  b. Fentanyl
  c. Midazolam
  d. Cisatracurium

Question 2

The train-of-four response is used to assess a patient's level of paralysis during high-frequency oscillatory ventilation, and the patient's foot twitches four times. The most appropriate evaluation of this circumstance is which of the following?
 
  a. Nothing need be done; paralysis is ade-quate.
  b. The paralyzing agent is moderately effec-tive.
  c. The paralyzing agent needs to be readmin-istered.
  d. Propofol needs to be added to enhance the effect.

[Anton]

Answer to Question 1

ANS: D
Neuromuscular blocking agents are used to facilitate less conventional mechanical ventilation strategies. Cisatracurium is a nondepolarizing paralytic agent. Propofol is an anesthetic. Fentanyl is an opioid, and midazolam is a benzodiazepine.

Answer to Question 2

ANS: C
For the train-of-four assessment, an electrical current consisting of four impulses is applied to the peripheral nerve over 2 seconds; the muscle contractions (twitches) produced provide information about the level of paralysis. With four twitches, the paralyzing agent needs to be readministered if continued paralysis is required.