The RT responds to the high pressure, high respiratory rate, low ...

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The RT responds to the high pressure, high respiratory rate, low exhaled volume, and low ex-haled minute volume alarms of a mechanically ventilated patient in the ICU
 
  Upon entering the room, the RT notices that the patient, who is still attached to the ventilator, appears diaphoretic, tachypneic, tachycardic, and hypertensive. Breath sounds are absent on the left and distant on the right. The patient's trachea is deviated to the left, and jugular vein disten-tion is present. The endotracheal tube is 24 cm at the teeth. Immediate action should include which of the following?
  a. Order a chest radiograph in the upright position.
  b. Administer intravenous etomidate and succinylcholine.
  c. Pull back the endotracheal tube to 22 cm at the teeth.
  d. Insert a 14-gauge needle into the second intercostal space right midclavicular line.

Question 2

Shear stress is most likely to affect a patient with which of the following?
 
  a. PA = 35 cm H2O; Ppl = 21 cm H2O
  b. PA = 35 cm H2O; Ppl = 12 cm H2O
  c. PA = 45 cm H2O; Ppl = 33 cm H2O
  d. PA = 50 cm H2O; Ppl = 38 cm H2O

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Answer to Question 1

ANS: D
The ringing of the high pressure alarm for a time has led to the sounding of the low volume and low minute volume alarms. The patient is in apparent respiratory distress, as evidenced by the tachypnea, tachycardia, and diaphoresis. The position of the ET tube at the 24-cm mark is evi-dence that the tube has slipped into the right mainstem bronchus. However, the absence of breath sounds on the left plus the tracheal deviation to the left, along with the jugular vein distention, is evidence of a tension pneumothorax on the right side. The ET tube appears to have slipped into the right mainstem bronchus and subsequently caused a pneumothorax. This is a life-threatening situation, and the pneumothorax must be decompressed immediately with a 14-gauge needle in-serted into the second or third intercostal space on the right midclavicular line.

Answer to Question 2

ANS: B
The amount of shear stress across the entire lung can be estimated using the transpulmonary pressure (Pplateau  Ppl), where Pplateau represents PA and Ppl is the intrapleural pressure.