A 49-kg female patient intubated with a size 7 mm inner diameter ...

[littleanan]

A 49-kg female patient intubated with a size 7 mm inner diameter (ID) endotracheal tube is being mechanically ventilated in the volume-controlled continuous mandatory ventilation (VC-CMV) mode.
 
  During patient rounds, both the low-pressure and low-volume alarms are sounding persistently on the ventilator. Upon observation of the patient, the respiratory therapist hears murmuring from the patient, with audible sounds during inspiration. The cause of this condition is which of the following?
  a. Circuit leak
  b. Endotracheal tube (ET) cuff leak
  c. Circuit disconnection
  d. Incorrect ET tube size

Question 2

A 46-year-old male patient is 2 days post-op for surgery to repair an aortic aneurysm. He is cur-rently receiving mechanical ventilation. Auscultation of the anterior and posterior chest reveals bilateral late inspiratory crackles.
 
  Percussion is dull in both lower lobes. A STAT radiograph reveals bibasilar infiltrates. The most likely cause of this patient's clinical presentation is which of the following?
  a. Asthma
  b. Pneumonia
  c. Pneumothorax
  d. Pleural effusion

[cat123]

Answer to Question 1

ANS: B
If a leak is present during a positive-pressure breath, air can be heard escaping from the patient's mouth. If there is a large enough leak, the ventilator's low-pressure and low-volume alarms will sound. A circuit leak or disconnection would cause the low alarms to sound but not cause the leak around the endotracheal tube cuff. An incorrect endotracheal tube may cause a leak around the cuff. However, a size 7 mm ID is appropriate for this particular size patient.

Answer to Question 2

ANS: B
Late inspiratory crackles and infiltrates on the chest X-ray are indicative of consolidation due to pneumonia. A patient having an asthma exacerbation would present with wheezing, hyperreso-nance on percussion, and increased radiolucency on X-ray. A patient with a pneumothorax would have unilateral absence of breath sounds, hyperresonance on percussion over the affected area, and lack of vascular markings over the affected area on X-ray. A pleural effusion manifests itself on X-ray as a blunting of the costophrenic angle on the affected side, a pleural friction rub just above the fluid level, and dullness to percussion over the pleural effusion.