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Kettering (Special Procedures) Questions With Complete Solution
Question 1: Explain the purpose of Hyperbaric Oxygen Therapy
(HBO)
CORRECT ANSWER : Means of increasing the PO₂ by
increasing the barometric pressure
Question 2: List the diseases/disorders that can be treated with
hyperbaric O₂ therapy
CORRECT ANSWER: CO poisoning, Decompression sickness
(bends), Tissue transplants/graphs, Anaerobic infections (gas gangrene)
Question 3: What are the pressures in which HBO therapy is
conducted?
CORRECT ANSWER : Most HBO therapy is conducted at
pressures between 2-3 atmosphere pressure absolute (ATA). a) Typical chamber can provide pressure between 2-6 ATA.
Question 4: Describe how the respiratory therapist would
administer oxygen to a patient receiving hyperbaric oxygen therapy
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CORRECT ANSWER : It is administered by mask or through
the chamber at 100%
Question 5: Describe the purpose of utilizing Helium/Oxygen
therapy for patients who have increased work of breathing (WOB)
CORRECT ANSWER : Decreases the patient's WOB by
delivering low density gas (most important property) that can easily maneuver around obstructions
Question 6: State the indications of Helium/Oxygen therapy
CORRECT ANSWER : Post extubation stridor, Severe
asthma/status asthmaticus, Obstructive tumors, Foreign object aspiration, Partial vocal cord paralysis
Question 7: List the two He/O₂ mixtures that are available
CORRECT ANSWER : 80% He/20% O₂ (most used), 70%
He/30% O₂
Question 8: What type of oxygen administration device is used
to deliver Helium/Oxygen therapy?
CORRECT ANSWER : Non-rebreathing mask
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Question 9: What would the actual flow rate be if a 70/30 heliox
mixture is used with an oxygen flowmeter set at a rate of 8 L/min?
CORRECT ANSWER : Actual Flow= indicated flow × factor,
Factors: a) 80/20 mixture: 1.8 (or use 2), b) 70/30 mixture: 1.6,
Ex: Actual Flow = indicated flow × factor, Actual flow = 8
L/min × 1.6, Actual flow = 12.8 L/min
Question 10: Describe the physiologic effects of Inhaled Nitric
Oxide (iNO) on the pulmonary system
CORRECT ANSWER : Inhaled Nitric Oxide (iNO) acts as a
potent pulmonary vasodilator, which improves pulmonary blood flow and PaO₂, but does not affect systemic blood pressure.
Question 11: List the 4 indications for inhaled nitric oxide
therapy
CORRECT ANSWER : Primary pulmonary hypertension,
Refractory hypoxemia related to increased pulmonary artery pressure (PAP), Increased pulmonary vascular resistance (PVR), Right heart failure/Cor Pulmonale
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Question 12: State the standard initial dose for iNO therapy
CORRECT ANSWER : 20-40 ppm (parts per million), * Start at
40ppm if given 2 choices.
Question 13: Describe the side effects that can occur during iNO
therapy
CORRECT ANSWER : Methemoglobin (MetHb) levels may
increase, Nitrogen Dioxide (NO₂) levels may increase and are toxic to body levels > 10 ppm, Rebound pulmonary hypertension- occurs when the iNO is discontinued too rapidly
Question 14: What should the therapist do to avoid a rebound
effect when discontinuing iNO therapy?
CORRECT ANSWER : Titrate the iNO dose to 20 ppm, then 10
ppm to, 5 ppm, then discontinue
Question 15: Identify the device that is used to deliver iNO
therapy to mechanically ventilated patient.
CORRECT ANSWER : injector module and sample line added
to ventilator circuit distal to humidifier and 24 inches after inspiratory limb