10-25 review

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At what altitude are you at risk for Compensatory stage?

10,000-15,000 ft

What rate do you set someone to optimize the exhalation process?

10-12bpm

Time constant of 0.5sec (5 time constant) means it takes ______% of the volume to be inhaled or exhaled?

100%

How do you mix a bag dose for vasopressin?

100mL NS-Add 20 units of Vasopressin (1unit/5mL)= 2units/10mL

What is the target minute ventilation formula?

100mL/kg/min

What is the perfect chloride state?

102

What is the mechanical dead space for a 8 year old intubated PT with a PIP of 10cmH2O?

10mL

What is the administration dose for vassopressin?

10mL q 2min

What is the normal range of RDW?

11-15%

What is a normal Hemoglobin level for females?

12-16 g/dL

What is a normal Hemoglobin level for a female??

12-16g/dl (female) Remember Females "mature" faster than males usually at the age of 12-16

What is the average Vo2?

120-150mL O2/min/1.7m

What is a normal sodium range?

135-145

What is a normal Sodium level?

135-145 mEq/L

What is the normal hemoglobin range for a male?

14-18

What is a normal Hemoglobin level in males?

14-18 g/dL

What is a normal Hemoglobin level for Males?

14-18 g/dL. Remember Men "Mature" around the age of 14-18

What is the PSI at 0 feet? What atmospheric stage are you in?

14.7PSI at stage 1

When intubating in a moving vehicle. your have a ___________ increase or decrease in saturation?

15% decrease

At what height do you reach the disturbance stage?

15,000-20,000 ft

At 40,000ft what is your useful time of consciousness?

15-20 seconds

What is a normal platelet count?

150,000-400,000/mcL

The average adult looses how much mL per breath?

150mL

What is a normal Corrected anion gap?

16-20 Over that may point to metabolic acidosis

what percentage of WBC's are Lymphocytes?

18-45%

How do you define ARDS?

1: Acute onset 2: Bilateral infiltration 3: PAWP <18mmHg 4: PaO2/FiO2<200

What is the indication for RSI?

1: Failure of airway maintenance/protection 2: failure of oxygenation/ventilation 3: they can not follow commands, control secretions, follow the clinical course.

What is a abnormal chest X-ray you will find with a COPD PT?

1: Flattening of the diaphragm 2: Increased AP diameter of the chest 3: Long, narrow heart 4: Abnormal air collection in the lung.

What are the two things we should consider with V/Q mismatch and shunt?

1: Is this an oxygenation issue? 2: Is this a ventilation issue?

What are the three P's of ETCO2?

1: Pulse: do they have a pulse, is it perufing? 2: Perfusion: Do they have a normal MAP? 3: Ph. What is the PT's Ph (low Ph can symbolize metabolic acidosis) DKA, Aspirin overdose, etholine poison are the main causes.

What is the process of looking at a chest x-ray?

1: separate from left and right. 2:look at the pleural of the lung (should not be able to see it) if seen then you have air in the pleural space. 3: look between each rib individually. 4: Look for the fissure lines (separation of lobes) should not be able to see it. 5: look at the diaphragm. look for the costophrenic angles. 6: identify the stomach, look for the gastric bubble 7: Look at the heart and its structures.

What is a normal I:E ratio for adults?

1:2

What is a normal I:E ration for Pediatrics?

1:3 is the starting number.

What is a starting I:E ration for someone with Obstructive lung disease?

1:4 ratio

What are some symptoms of ARDS?

1:Diffuse alveolar damage and lung capillary endothelial injury. 2: Associated with increased pulmonary vascular permeability. 3: Decrease lung compliance.

For every unit of PRBC administered you increased your HgB by ________ you icrease your Hct by _________?

1g/dL, 3

What is the equation for anatomical dead space?

1mL X ideal body weight in pounds

How do you prepare a mix of neo-synephrine?

1mL neo-synephrine. Add to 100mL bag of NS= 100mcg/mL

What is the administration push dose for vasopressin?

1mL q 2min

How much ATP is produced in glycolysis?

2 ATP

3: For every 1000' ascended, the temperature will decrease by how much?

2 degrees celcius

At 28,000ft what is your useful time of consciousness?

2-3 minutes

What percentage of oxygen going to the tissue dissolves in plasma?

2-3%

Given the Inspiratory flow of 30L/cmH2O minute, PIP 20 and Pplat 16, calculate the expiratory time needed for this PT.

2.4 seconds. A: inspiratory flow 30L/cmH2O minute B: PIP 20cmH2O-Pplate 16 cmH20 C: Time constant calculation.

Smokers lose how much night vision capability at sea level?

20%. This equals to a physiological altitude of 5,000 ft.

At what altitude do you hit the critical stage?

20,000-25,000.

At 18,000ft what is your useful time of consciousness?

20-30 minutes

What is the normal relationship between HCO3- and Carbonic acid?

20:1

What percentage of oxygen do we breath?

21%

What is a normal HCO3-?

22-26 remember HCO3- is metabolic.

What is the normal range of Bicarbonate?

23-30 mEq/L

What is a normal MCH?

23-31pg

At 35,000ft what is your useful time of consciousness?

30-60seconds

For every ____ feet under water you gain _______ ATMs?

33 feet you gain 1 ATM.

What is a normal PaCO2?

35-45 mmHg Remember PaCO2 is respiratory.

Aerobic metabolism produces a total amount of ___________ ATP?

During Oxidative phosphorylaiton how many net ATP do you produce?

What is the normal hematocrit range for a female?

37-47

What is a normal level of hematocrit for a fewmale?

37-47% Remember multiply their hemoglobin by 3

What is a normal SID?

How deep do you push a ET tube?

3X size.

You have a diver at 99 feet under water. What ATM are they in?

4 atm. Remember 0ATM (sea level) is still one level. Divide 99 by 33= 3 and then add the extra 1 from sea level.

Hemoglobin is made up of what?

4 strands of amino acids

What is a normal White blood cell count?

4,500-10,500 cells/mcL

What are normal WBC levels?

4,500-10,500/mcL

What is a normal PAWP?

4-12 mmHg

What is a normal Pulmonary capillary wedge pressure?

4-12mmHg

What is the range of VE (minute ventilation) for an adult?

4-8L/min

A patient's SpO2 is demonstrating 70%. Provided a normal OHC, what is the estimated PaO2?

40mmHg

What is a normal Hematocrit for a male?

42-52% Remember times their hemoglobin by 3

What percentage of WBC's are Neutrophils?

45-75%

The average adult stomach holds how much liters of volume?

At 22,000ft what is your useful time of consciousness?

5-10 minutes

What is the administration dose for Epi in AAM?

5-20 mcg q 1-5min

Flickers vertigo can cause seizures, What is the Hertz range of flickers vertigo?

5-20Hz

how much lung volume is lost when we lay a PT flat?

50%. sitting a PT at a 30-35 degree angle to optimize lung recruitment

What is the administeration dose for Neo-synephrine?

50-200mcg q 1-5 minutes

What is the minute bias flow for a trigger setting of 3L?

50mL/sec 3mL/min=3,000mL 1min=60 Sec Divide bias flow by 60sec equals 50mL/sec

A patient has an SpO2 of 87%. What would the approximate PaO2 be?

57mmHg

A PT's SpO2 is 88. What is the PaO2?

58. Minus 30 from the SpO2 and that gives you a rough estimate of the PaO2.

The average minute ventilation for an adult is what?

What is the average cardiac output for an adult?

5L/min

What is the correct endotracheal tube placement?

5cm above the carina

PaO2 will decrease by _______mmHg per 1000ft increase in altitude?

5mmHg

Where do you insert a chest tube?

5th intercostal, mid-axillary

How much Co2 is produced after the Kreb cycle?

6 CO2 molecules

What is a normal Blood Urea Nitrogen (BUN)

6-23mg/dL Remember a "Burger" (buN) cost between 6-23 dollars

What is a normal tidal volume?

6-8mL/kg (PT's ideal weight)

You have a 12month old that is intubated. Their weight is 10kg. What is their Vt?

60-80mL

Time constant of 0.1sec (1 time constant) means it takes ______% of the volume to be inhaled or exhaled?

63%

What is a normal ET tube size for a women?

7.0-8.0

What is a normal MAP for an adult?

70-100. Anything below 60 then the kidneys will not be perfused properly

What is the atmospheric pressure at sea level?

760mmHg or 760 torr

If the atmospheric pressure at 18,000 ft. MSL is 380 torr, what would the partial pressure of oxygen at that altitude?

79.8 Remember at the altitude you have 380torr. 380 X 0.21= 79.8

What is the normal size for a ET tube size in males?

8.0-9.0

What is the normal PaO2 on an ABG?

80-100

What is a MVC range?

80-95fL

With a sensitivity set to 5 L/min on the Revel ventilator, how much flow volume would the patient have to change in order to trigger a breath?

83mL/sec Remember Convert 5L/mL. Convert 1min/sec. finally divide 5,000mL/60sec

What is the level of moderate hypoxia?

85-90%

Time constant of 0.2sec (2 time constant) means it takes ______% of the volume to be inhaled or exhaled?

86%

The PT's SvO2 is 79%. What is the PT's estimated ScvO2 and why?

87%. The SvO2 is usually 5-8% lower than the ScvO2.

What is a normal Calcium level?

9-11 mg/dL Remember "CAL"cium 911 actual number is 8.8-10.4

What is a normal Uncorrected anion gap?

9-12

Explosive decompression at about 43,000 feet what is you usual time of useful consciousness?

9-12 sec

At 43,000 and above what is your time of useful consciousness?

9-12 seconds

Time constant of 0.3sec (3 time constant) means it takes ______% of the volume to be inhaled or exhaled?

95%

What is a normal chloride range?

95-105 mEq/L

What is a normal Chloride level?

95-105 mEq/L Remember that I want to be in the pool when it is about 95-105 degrees.

Time constant of 0.4sec (4 time constant) means it takes ______% of the volume to be inhaled or exhaled?

98%

What is a normal BNP

<100 pg/mL

What hemoglobin level do PT's typically need a transfusion?

<7g/dL

At what systolic limit does ketamine become dangerous?

>180mmHg

What is a normal Pplat?

>30

Oxygen extraction ration above 40% points towards what?

A PT in anaerobic metabolism.

High osmolality state indicates what?

A concentrated stated. Diabetes insipidus

What is surfactant?

A detergent like complex, reduces surface tension and helps keep the alveoli from collapsing.

Low osmolality state indicates what?

A diluted state. SIADH

What is Barotitis Media?

Airplane ear is also called ear barotrauma, barotitis media or aerotitis media. Self-care steps — such as yawning, swallowing or chewing gum — usually can counter the differences in air pressure and improve airplane ear symptoms

What is the Compensatory stage of hypoxia?

Altitude 10,000-15,000 SpO2 80-90% Advanced symptoms from stage 1 Night vision < 50%

What is the indifferent stage of hypoxia?

Altitude of 0-10,000ft SpO2- 90-98% Decrease in night vision at 4000ft HR and RR increase

What does Pplat represent

Alveolar health. High Pplat can point to high pressure that could damage the lungs, alveoli and cause ventilator lung injury, inflammatory cascades, and barotrauma.

What is BNP?

B type natriuretic peptide. This is secreted by the ventricular tissues in the heart when ventricular volumes and pressure in the heart are increased. Sensitive indicator

What is the indications for fentanyl in the AAM?

Blunting of circulation response to intubation or suspected known increased ICP or cardiovascular disease.

What are the main causes of V/Q mismatch and shunt?

COPD Asthma Trauma Pneumonia ARDS

What kind of PT's might have higher than normal carboxyhemoglobin levels?

COPD PT's

You pull a 24 yo out of a burning building. SpO2 reads 82% despite proper oxygen therapy. What most likely is going on with this person and why is this happening?

Cyanide poisoning. Due to Cytochrome C oxidase.

What does the D in GOLD mark stand for?

D-lactate

What is D lactate?

D-lactic acidosis is an unusual form of lactic acidosis that can occur in patients with short bowel syndrome

What law is the gas law of partial pressure?

Dalton's law.

Change in concentration is an example of what law? how do you do it?

Dalton's law. Increase FiO2

What is 2-3 DPG?

- Produced during RBC glycolysis. Facilitates off-loading of O2 - Increased = Right shift / Decreased = Left shift - Banked blood = *↓* 2,3-dpg

What is a normal BE?

-2 to +2

What is a normal base excess?

-2 to +2

At what altitude are you at risk for indifferent stage?

0-10,000 ft

What percentage of WBC's are Basophils?

0-2%.

What is a normal CK-MB?

0-3 ng/mL

What percentage of WBC's are Eosinophils?

0-7%

What is the dose for atropine in advanced airway management?

0.02mg/kg (min 0.1mg, max 0.5mg)

What is a normal QRS complex?

0.04-0.12 seconds.

What is the normal range of troponin?

0.04ng/mL

The PaCO2 increased by 10 mmHg, which dropped the pH by_______?

0.08

For every 10mmHg change in PaCO2 the ______will change by?

0.08 opposite direction

What is a normal PR interval?

0.12-0.20 seconds

For every 10mEq/L change in HCO3- the pH will change by __________ ?

0.15 in the same direction

For 10mEq of potassium given you raise the PT's potassium by ________?

0.1mEq/L

What is the dose for etomidate?

0.3 mg/kg

What is the ideal time constant?

0.3 sec= 3 times constant means it takes 95 of the volume to be inhaled or exhaled

What is a normal BHB?

0.4-0.5 mmol/L

For every change in pH of 1.0 the K+ will change by.

0.6 in the opposite direction.

For every 0.10 change in pH, the K+ moves __________?

0.6 in the opposite direction;

What is a normal Creatinine level?

0.6-1.4mg/dL

What is the "I" time for a PT with 16RR with an I:E ration of 1:3?

0.93 seconds Remember divide the RR by 60seconds and that gives you the the respiratory cycle. From there take the product and divide that by 3 and the remainder is your "I" time

4: For every 150 meters ascended, the temperature will decrease by what?

1 degree Celsius

What is SID?

Strong Ion Difference Difference between sodium and chloride state

When calculating a PT's oxygen consumption, the providers knows it is best to draw blood from the?

Subclavian triple lumen catheter.

What are the depolarizing agents?

Succinylcholine (anectine)

What is the dose for Anectine?

Succinylcholine 1.5-2.0mg/kg

Which paralytic "burns" oxygen?

Succinylcholine.

What is the contraindication for Anectine?

Succinylcholine: Allergy to drug, known or suspected hyperkalemia, Hx of malignant hyperthermia, burns and crush injury, spinal cord injury, stroke in the last 5 days-6months, neuromuscular disease, myopathy.

What is the indication for anectine?

Succinylcholine: paralysis for RSI

What is the SALAD technique?

Suction, assistant, Larango airway decontamination technique

What are some physical findings for a pulmonary embolism?

Tachypnea and tachycardia, rales, diaphoresis, S3 and S4 gallop, cardiac murmur.

What are some causes of a microcytic state with high RBC's?

Thalassemia issue

You have a 48yo african american male with the following findings on their CBC. What might be going on? Hgb: 11.1 g/dL Hct: 33.3% RBC: 7.1 million/mcL MCV: 67.8 fL MCH: 20pg RDW: 13.5%

Thalessemia

What is Bias flow?

Flow trigger. used to clear CO2 out of the circuit during exhalation also used as a flow sensor or a flow trigger

What is Gay Lussac's law?

For a given mass and constant volume of a gas, the pressure exerted on the sides of its container is directly proportional to its absolute temperature.

How do you calculate ATM's?

For every 33ft we ascend or descend we enter another ATM.

What is FiO2?

Fraction of inspired oxygen

What is the "GOLD MARK" for identifying metabolic acidosis?

G: Glycols O: Oxoproline L: L-Lactate D: D-Lactate M: Methanol A: ASA R: Renal Failure K: Ketoacidosis

High PaCO2 points to _______ acid?

Gained acid

Low HCO3 points to ________ acid?

Gained acid

What kind of law is Dalton's law?

Gas law of partial pressure

As temperature goes up, gas volume does what?

Gas volume expands

What are some findings you will have with someone with hyperkalemia?

Generalized fatigue, Metabolic acidosis, Paralysis, Palpitations, Bradycardia, New onset of a 2nd or 3rd degree heart block, Edema, diminished

Aeurobic metabolism of ATP required __________ and _______ and the byproducts are ________ and __________

Glucose and O2. CO2 and H20

What does the G in GOLD mark stand for?

Glycols

Both Aerobic and Anaerobic metabolism start with what?

Glycolysis.

Gasses that move from an region of higher concentration to an area of lower concentration is an example of what law?

Graham's law

What makes a Q wave pathologic?

Greater than 1mm wide, Greater than 2mm deep, and greater than 25% depth of the QRS

The PT has a ETCO2 of 40mmHg. The Provider estimates taht the PaCO2 is?

Greater than 42. Remeber the PaCO2 will always be higher than the ETCO2

What is the HEAVEN mneumonic for airway management?

H: Hypoxemia -DL E: Extremes of size-VL A: anatomic disruption/obstruction-VL V: Vomit/blood/fluid-DL/VL E: Exsanguination-DL N: Neck Mobility-VL

A patient has an ABG demonstrating the following: pH 7.54, PaCO2 15, HCO3-23. How would you change this blood gas to reflect a partially compensated respiratory alkalosis?

HCO3- of 17 mEq/L To make this a partially compensated respiratory alkalosis the HCO3- would have to be less than 22 mEq/L.

What part of the blood has the biggest affect on oxygen delivery?

Hemoglobin

A patient suffering from decompression sickness is an example of which gas law?

Henry's

The amount of gas dissolved in a solution is directly proportional to the pressure of the gas over the solution. What is this?

Henry's law.

Placing a gas under pressure is an example of what law? How is it performed?

Henry's law. BVM or ventilator management.

What are the hemodynamic parameter changes with a PE?

High RV and PAP (pulmonary artery pressure) High CVP Low to normal PCWP (Pulmonary capillary wedge pressure) Low to normal CO

What are some common causes of increased RBC count?

High altitude, compensation for hypoxia, dehydration.

How do you treat Barobariatrauma?

High flow O2 that will cause nitrogen to diffuse.

What are some causes of Elevated BUN?

High protein diet Renal failure Hypovolemia CHF

In P1V1=P2V2 what does P2 stand for?

Highest ATM based on the highest altitude

How long does the kidney buffer system take place?

Hours to days

Slow and wide V-tach (150-155) and the QRS is greater than .200ms. what might be causing the wide QRS complex?

Hyperkalemia. give them calcium gluconate or sodium bicarb.

What causes a right shift on the oxyhemoglobin dissociation curve? A: Decreased levels of 2-3 DPG B: Alkalosis C: Hypothermia, D: Hyperthermia

Hyperthermia

Your urine analysis shows greater than 20. What does this point to?

Hypervolemia due to possible resuscitaiton, Cushing's syndrome, Aldosteron, NaHCO3 administeration. treatment is Diuretic therapy or hypotonic solution.

The H in the DEATH acronym stands for what?

Hypoglycemia.

What are some findings you will find with someone in hypokalemia?

Hypotension, Ventricular arrhythmias, Cardiac arrest, Bradycardia, PAC or PVC, Hypoventilation, Lethargy, Decreased muscle strength, Decreased DTR's

A urine analysis shows of less than 10. What does this point to?

Hypovolemia. treatment of NS.

Based on Henry's law how do we change the concentration?

Increase FiO2 (Dalton's law)

What is the affininty in left shift oxyhemoglobin dissociation curve?

Increased affinity.

What is are the three things we should look for in a good X-ray?

RIP Rotation: PT isnt rotated in any way (look at the spinal process) I: inspiratio: did the PT take a deep enough breath P: Penetration: The degree of which the X-ray passed through the PT.

When administering high concentrations of oxygen to alleviate hypoxic hypoxia, you are altering which component of which gas law?

Solubility: Henry's law

What are the signs of critical stage?

SpO2 at 60-70% Inability to remain upright, Jerking upper limbs, Seizures, Rapid unconsciousness, Coma and death.

A MCV of greater than 95 is?

Macrocytic

You have a 76 yo female with the following CBC. The PT has a history of chronic anemia. What might be going on? Hgb: 7.6 g/dL Hct: 22.6% RBC: 2.3 million/mcL MCV: 126.3 fL MCH: 29pg RDW: 19.1%

Macrocytic. Probably B12 or folate defiviency.

What does the M in GOLD mark stand for?

Methanol

Are you aware of the indifferent stage of hypoxia?

How do you calculate Raw?

PIP-Pplat

What is heparin induced thrombocytopenia?

Platelet destruction that arises secondary to heparin therapy. Heparin can form a complex with surface molecules on platelets such as platelet factor 4. IgG antibodies against this complex, target the platelet for destruction by spleen.

What are some symptoms of emphysema?

Pink puffers. V/Q mismatch Destruction of airway Destruction of pulmonary capillary bed. Muscle wasting.

What is Pplat?

Plateau pressure (should be less than 30)

For every 1000 ft ascended temperature does what?

Decreased 2 degrees Cellcius

What are some causes of Macrocytic state with normal RBC's?

Drug induced

In regards to the Stressors of flight What does D.E.A.T.H. stand for?

Drugs Exhaustion Alcohol Tobacco Hypoglycemia

The primary purpose of the carbonic acid buffering system is to _______________ CO2.

Eliminate

In P1V1=P2V2 what does V2 stand for?

Ending volume as impacted by the highest altitude.

Why is potassium important?

Essential for cardiac, muscle, and CNS function.

What should you apply to the BVM if using the BVM to ventilate the PT in peri-intubation?

EtCO2

What are the signs and symptoms of chronic bronchitis?

Excessive mucus production Airway obstruction Hypoxemia, polycythemia Blue bloaters.

What does Vte stand for?

Exhaled tidal volume.

The E in the DEATH acronym stands for what?

Exhaustion.

What is the level for severe hypoxia?

less than 85%

A high CK-MB indicates what?

likely cardiac damage.

You should maintain the lowest FiO2 possible in order to do what?

maintain proper tissue oxygenation.

What does MCH mean?

mean corpuscular hemoglobin: amount of hemoglobin per red blood cell

What is MCV?

mean corpuscular volume - average volume and size of individual red blood cells

What is Menorrhagia?

menstration that last more than 7 days.

What is exhaled tidal volume?

most accuratge measurement of the volume received by the PT.

Never Let Monkeys Eat Bananas. What does this mean?

neutrophils, lymphocytes, monocytes, eosinophils, basophils. Types of white blood cells.

What is Triggering?

our way of allowing the ventilator to recognize a change in flow

What is the Bohr effect?

The Hemoglobin oxyen binding affinity is inversely related both to acidity and the concentration of carbon dioxide.

You calculate a PT's oxygen extraction ration at 52%. What does this mean about their metabolism?

The PT is likely in anaerobic metabolism.

Without treatment what happens on a ECG with someone in hyperkalemia?

The PT wave eventually disappears and the QRS widens, resembling a sine wave. And eventually VF or asystole

What is SaO2?

The amount of Hgb (Hemoglobin) in the blood that are saturated.

What is Henry's Law?

The amount of gas dissolved in a solution is directly proportional to the pressure of the gas over the solution.

How would you define henry's law?

The amount of gas in a solution is proportional to the partial pressure of gas above the solution

What is anatomical dead space?

The amount of gas that stays in the pipes and does not reach the aveoli

What is the altimeter setting (reading)?

The barometric pressure at a current location.

What is the DEATH act?

The current stressors of flight. the DEATH acronym for Drugs, Exhaustion, Alcohol, Tobacco, and Hypoglycemia.

What is DO2?

The delivery of oxygen each minute.

What is a Sedative?

The depression of a PT's awareness to the environment and reduction of his or her responsiveness to external stimulation.

In regards to ABG's what is the First, middle, and last name perspective?

The first and last name will derive from the pH and the Middle name will derive from the cause.

What is Peek inspiratory pressure?

The highest level of pressure applied to the lungs during inhalation.

What is L-Lactate?

The lactate that we build during glycolosis.

What is a time constant?

The length of time it takes for the lung units to fill or empty

What is preload?

The low pressure side of what comes in to the superior/inferior venacava drops into the right atriam and moves to the right ventricle.

What is SvO2?

The mixed venous oxygen saturation (pulmonary artery cath)

What is the subclavian triple lumen catheter?

The most commonly used catheter for central venous access is the triple lumen catheter. They are preferred (particularly in the ICU) for their three infusion channels that allow for multiple therapies to be administered simultaneously.

What is tidal volume?

The normal volume of air inspired during each breath

The flat upper portion of the S-shaped OHDC represents what?

oxygen loading onto hemoglobin in the lungs

The The steep lower part of the OHDC (under the "knee") represents what?

oxygen released from hemoglobin to capillaries at the tissue level.

What is a normal pH for a human?

pH (7.35-7.45)

What are monocytes?

phagocytes that migrate from blood into tissue to become macrophages. They clean up a site and clean up dead tissue.

What is the post management plan?

place the PT on the ventilator, secure airway, continued pain management, continued sedation, and consider paralysis is recent measures are not enough

What is Albumin?

plasma protein

What are thrombocytes?

platelets Remember too much platelets can cause a blood clot "Thrombosis"

On a Xray you see the PT has a loss of a costo phrenic angle and a flattening of the diaphragm

plural effusion

What is cytochrome C oxidase?

The terminal oxidase of cellular respiration and catalyzes the transfer of electrons to molecular oxygen. This process is blocked by cyanide and blocks the oxidative process, thus leading to cellular anaerobic respiration.

What is Dalton's Law?

The total pressure of a gas mixture is the sum of the partial pressures of all gases. In addition, it describes how a pressure is exerted by a gas at various altitudes, and how that pressure affects the partial pressure of the said gas.

What is SpO2?

The total saturation of oxygen bound to Hgb.

What does elevated Creatinine level symbolize

poor creatinine clearance (kidney issue), hypovolemia

What are the CNS effects during the compensatory stage?

poor judgment, irritable, drowsiness, decreased coordination.

What does the GOLD MARK represent?

possible metabolic acidosis.

The dominant intracellular cation is:

potassium

dark spaces on a x-ray point to what?

presence of air

What is minute ventilation?

The volume of gas inhaled and exhaled in a minute

What is mechanical dead space?

The volume we loose in the circuit during a volume breath based on the Peek inspiratory pressure.

Asthma and COPD are part of the 50/50 club. What does that mean?

Their PaCo2 is greater than or equal to 50mmHg and their PaO2 is usually less than or equal to 50mmHg

What is cortisol?

This term refers to a corticosteroid hormone released fro the adrenal cortex that stimulates gluconeogenesis increases mobilization of free fatty acids, decrease use of glucose, and stimulates catabolism of proteins. Also known as hydrocortisone.

ARDS increase dead space T or F?

True

Hemoglobin may be fully saturated with dysfunctional strands, T or F?

True

What does Bicarbonate symbolize?

Total amount of CO2

What is CaO2?

Total content of oxygen bound to Hgb.

You have a PT in metabolic acidosis with a related elevated potassium level (hyperkalemia) what do you teat first?

Treat the underlying cause, metabolic acidosis.

The first stage of any shock is based of alkalosis T or F?

True. Due to the hyperventilation or over comensation of the body.

What is a great way to secure an advanced airway?

Tube tamer, C-collar

What is BNP used for?

Used as a marker for CHF patients.

What is Oxidative phosphorylation?

Uses energy released by the electron transport chain to power ATP synthesis.

How do you calculate PaO2 from SpO2?

subtract 30 from SpO2

What is Base excess?

the amount of strong acid or base required to titrate 1 L of blood to pH 7.40 at 37 degrees C while pCO2 is held constant at 40 mm Hg

What is Vo2? what does it represent?

the body's consumption of oxygen.

What is glycolysis?

the breakdown of glucose by enzymes, releasing energy and pyruvic acid.

What is norcuron?

Vecuronium.

What is the dose for norcuron?

Vecuronium: 0.1mg/kg

What is the indication for Norcuron?

Vecuronium: long term paralysis.

What is V/Q mismatch?

Venous Admixture. An imbalance in the amount of O2 received in the alveoli and the amount of blood flowing through the alveolar capillaries

What are leukocytes?

white blood cells. Remember "Leuk" from star wars is white.

In V/Q Mismatch what does V stand for?

Ventilation

How do you calculate respiratory cycle time?

divide 60 sec by the RR.

What is vertigo?

dizziness, balance problems.

How do you calculate time constant?

first take Raw/Flow. Then take the byproduct and multiply that by the time constant.

what is pulmonary edema?

fluid in the lungs

How is Hgb measured?

g/dL Remember to convert dl to mL when convert/simplify

What are some causes of a microcytic state with normal-low RBC's?

iron deficiency anemia lead poisoning Chronic inflamation sideroblastic anemia

What is oxygen extraction ratio?

it is the amount of oxygen extracted by the peripheral tissues divided by the amount of oxygen delivered to the peripheral cells

What is a strong ion difference?

Difference between sodium and chloride

What are some causes of hypovolemic state?

Diuretics, Burns, Vomiting. Cure is Isotonic fluids.

How do you calculate RR from Minute volume (VE) and Tidal volume (Vt)?

Divide VE/Vt

What is a normal L-Lactate?

Normal lactate range is less than 2.3 mmol/L.

What are some symptoms for someone who is hypocalcemic?

Numbness and tingling in perioral area or in the fingers and toes, muscle cramps, dysphagia, seizures.

What is stagnant hypoxia?

Obstructive shock, reduced cardiac output or pooling of blood such as heart failure, PE, Shock

What are oxygen free radicals?

Often refured to as Reactive Oxygen Species (ROS) is a byproducts of cellular oxidation and can cause cellular damage.

What does the O in GOLD mark stand for?

Oxoproline

How can you tell if the right atrium is enlarged on a ECG?

P wave >2.5mm (lead II)

Explain P1 V1= P2 V2?

P1= starting ATM (atmospheric pressure) at the lowest altitude V1= Starting volume (epigastrium, lung, ETT cuff) P2= highest ATM based on the highest altitude V2= Ending Volume as impacted by the highest altitude.

What is the preferred route for obtaining a chest xray?

PA view. Posterior Anterior

As we go lower than sea level what happens to the pressure and the atmospher?

Pressure goes up and atmosphere goes up.

What are the indications for atropine in the advanced airway management?

Prevention and treatment of bradycardia in pediatric PT's less than 1 yr with use of succinylcholine and the treatment of bradycardia in adult PT's during RSI

What is Creatinine?

Product of muscle breakdown, measurement of kidney function

Oxygen delivery (DO2) is a product of what?

SaO2, Hgb, Cardiac output.

How do you make a "quick press" epi push?

Saline flush- Expel 1mL (9mL left). Add 1mL epi 1:10,000= 10mcg/ml

How do you mix a push dose of vasopressin?

Saline flush-expel 1mL. Add 20 units of vasopressin=2units/mL

What is 1ATM?

Sea level (one atmosphere)

How long does the Carbonic acid-bicarbonate buffer system take place?

Second to second.

What is the indications for Ketamine in AAM?

Sedation for induction with severe bronchospasm, RSI, Excited delirium, Pain management.

What are the indications for etomidate in AAM?

Sedation for induction/neurological protection

What is a high shock index (mortality potential)?

anything greater than 0.9

What is a prominant U wave?

appearing with a QT prolongation is one of the signs with Digoxin overdose or Hypokalemia

What is acetylsalicylic acid?

apsirin -major NSAID due to wide range of effects

When does maintaining the lowest FiO2 doesnt really matter?

trauma, Pregnancy

What intubation technique is recommended for Exsanguination PT's?

DL (direct)

What intubation technique is recommended for Vomit-blood-fluid in the airway PT's?

DL/VL (direct and Video)

How do you calculate Desired O2 per altitude?

%FiO2 X P1/P2 P1=current barometric pressure P2=New barometric pressure at altitude.

How do you calculate desired O2?

(%FiO2 X P1)/P2 P1(in this formula) is current barometric pressure P2(in this formula)= New barometric pressure at altitude.

What is a quick calculation for ideal body weight?

(2.0 X PT height in inches>60) + 50kg

How do you calculate MAP?

(2XDBP) + SBP/3

How do you calculate bedisde PaCO2?

(700 torr X FiO2)-50

how do you calculate PaO2?

(700torr X FiO2)-50

How do you calculate ETT size for pediatrics?

(Age+16)/4

How do you calculate what the trigger will be?

(sensitivityL converted to mL)/60 sec

How do we treat ARDS?

-Treat cause -Oxygenation and ventilation (PEEP, low tidal volume (less than 400), possible non-traditional modes of ventilation (high-freq, pressure-control, and inverse-ratio--i.e. inspiration longer than expiration) -Decrease O2 consumption (sedation, pain relief, and paralytic agents) -Positioning (continuous lateral rotation therapy, prone positioning) -Fluid and electrolyte balance

What percentage of WBC's are Monocytes?

1-10%

At 30,000ft what is your useful time of consciousness?

1-2 minutes

What is the dose for Fentanyl in the AAM?

1-3mcg/kg (max of 250mcg)

What is the Dose for Ketamine in AAM?

1-4.5mg/kg- RSI 4mg/kg- Excited delirium 0.1-0.25 mg/kg- pain management for intubated PT's

What are the eight P's in airway management?

1. Preparation 2. Positioning 3. Preoxygenation 4. Pretreatment 5. Paralysis and induction 6. Protection and positioning 7. Placement and proof 8. Post-intubation management.

What is the normal range for urine specific gravity?

1.005-1.030

How do you calculate CaO2?

1.34 X Hgb X (SaO2)+PaO2 X 0.003

Each gram of Hbg carries ___________ of oxygen?

1.34mL

What are normal levels for Magnesium?

1.5-2.5 mEq/L Remember a "MAG"(nesium)nifying glass allows you to see things at 1.5-2.5X more than normal.

What is the standard number for BSA?

1.7msquared devide product of O2 delivery by 1.7msquared.

What is a normal serum osmolality range?

275-295 mOsm/kg

What is a normal Barometric pressure at sea level?

29.92 inHg inches of Mercury

What is the serum osmolality equation?

2NA+ + (Glu/18)+(BUN/2.8)

Hematocrit is usually _______ times the hemoglobin?

3 times

What is a normal phosphorus level?

3-4.5 mg/L Remember 1....2...."3"......phos"PHOR"us. Max of 4 and minimum of 3.

At 25,000ft what is your useful time of consciousness?

3-5minutes

What is a normal Albumin level?

3.5-5 g/dL

What is the normal levels of Potassium?

3.5-5 mEq/L Remember banannas usually come in 3-5 bannanas a bunch and you want them to be "half" ripe

Shortly after departing the Emergency Room, the provider notes that the patient's pH has changed from 7.42 to 7.33. If the patient's K+ was 3.4 mEq/L in the ER, what is it estimated to be now?

4.0 mEq/L For every 0.1 change in pH, the potassium will move 0.6 in the opposite direction. In this case the pH changed by 0.1 in a downward direction; therefore, the potassium will increase by 0.6 to 4.0 mEq/L.

Whats the normal RBC count for females?

4.2-5.4 million/mcL

What is a normal red blood cell count for a female?

4.2-5.4million/mcL

At 1ATM the stomach has 4L of volume secondary to an unrecognized esophageal intubation. The PT was taken to 3000ft with an Atm of 0.90. What would the new volume in the stomach be?

4.4L Explanation: P1V1/P2 1AtmX4L/0.9Atm= 4.4L

Whats the normal RBC count for male?

4.7-6.1million/mcL

What is a depolarizing agent?

A non-competitive medicine that exert their affect by binding with acetycholine receptors at the neuromuscular junction, causing sustained depolarizing of the muscle cell

What is consolidation?

A region of normally compressible lung tissue that has filled with liquid instead of air.

What is histotoxic hypoxia?

A result of poisoning or metabolic disorders such as cyanide, ETOH or CO poisoning.

Lactate formation is an indication of ___________________________________.

A stress response.

The provider knows a right-sided subclavian central line is placed correctly when the distal tip is: A: 1.0 to 1.5 cm above the carina B: 1.0 to 1.5 cm below the carina C: 2.0 to 2.5 above the carina D: 2.0 to 2.5 below the carina

A: 1.0 to 1.5 cm above the carina Right-sided central lines should be 1.0 to 1.5 cm above the level of the carina.

A patient is breathing at 40 breaths per minute. What is their respiratory cycle time? A: 1.5 seconds B: 0.6 seconds C: 2.0 seconds D: 2.1 seconds

A: 1.5 seconds Remember that in order to calculate the respiratory cycle time - divide 60 seconds by 40 bpm to get 1.5 seconds - this means that they have 1.5 seconds to both inhale and exhale.

The provider notes that the patient's blood glucose is 700 mg/dl and serum sodium level is 125 mEq/L. What is this patient's actual sodium level? A: 134.6 mEq/L B: 125.6 mEq/L C: 575.1 mEq/L D: 115.0 mEq/L

A: 134.6 mEq/L Remember that blood sugar is hyperosmolar and causes a shift of sodium. In this case, you would need to obtain a corrected sodium. ((700 mg/dl - 100) x 0.016) + 125 = 134.6.

Calculate the total tidal volume of a male patient who is 5'5" who is receiving 6 mL/kg. A: 360 mL B: 390 mL C: 310 mL D: 400 mL

A: 360 mL Remember that ideal body weight is calculated by inches over 60 x 2; and then added to 50 kg which in this case would be 60 kg x 6 mL/kg which would equal 360 mL total tidal volume.

The indifferent stage of hypoxia causes a reduction in night vision at what altitude? A: 4,000 ft B: 3,000 ft C: 2,000 ft D: 1,000 ft

A: 4,000 ft

Flicker Vertigo can cause seizures to occur at what Hertz (Hz) range? A: 4-20 Hz B: 40-80 Hz C: 20-60 Hz D: 8-12 Hz

A: 4-20 Hz

Calculate the mechanical deadspace on an adult patient who is being volume ventilated with a PIP of 40 cmH2O. A: 80 mL B: 40 mL C: 240 mL D: 120 mL

A: 80 mL In this example, the adult circuit is about 2 mL x PIP (40); so the mechanical deadspace is 80 mL. We could add this to the Vt to compensate for that loss.

A patient is in traumatic arrest. The crew is preparing to pre-oxygenate and RSI the patient. What is the next best action? A: Apply nasal cannula at 15 LPM and PPV with BVM every 7 seconds B: Apply nasal cannula at 15 LPM and a Non-Rebreather at 15 LPM C: Apply BVM ETCO2 and gently ventilate every 6 seconds D: Apply nasal cannula at 8 LPM and PPV with BVM every 7 seconds

A: Apply nasal cannula at 15 LPM and PPV with BVM every 7 seconds During apneic oxygenation, it is important to apply a nasal cannula at 15 LPM; and also ventilate with a BVM between every 6 to 8 seconds.

A patient has a capillary blood glucose of 600 mg/dl. To confirm DKA, the provider obtains which diagnostic test? A: Beta-Hydroxybutyrate B: Free fatty acids C: Serum ketones D: Urine ketones

A: Beta-Hydroxybutyrate Obtaining a Beta-Hydroxybutyrate level is the earliest marker of acidosis and ketone body production.

A patient on chemotherapy has reported feeling weak, tired and is short of breath on exertion. The likely cause of this patient's symptoms can be explained by: A: Decreased RBC count B: Increased RBC count C: Increased WBC count D: Decreased WBC count

A: Decreased RBC count A patient undergoing chemotherapy experiences bone marrow suppression which will reduce the overall RBC count, which accounts for all of the patient's symptoms.

The amount of gas dissolved in a solution is directly proportional to the pressure of the gas over the solution describes what gas law? A: Henry's B: Dalton's C: Charles' D: Boyle's

A: Henry's

A 70-year-old, 80 kg patient is intubated and being mechanically ventilated. Dopamine is infusing at 10 mcg/kg/min. Vital signs: BP 110/60, HR 110, RR 16 bpm assisted Ventilator settings: AC 16, Vt 550, PEEP 3, FiO2 0.6 ABG results: pH 7.34, PaCO2 50 mmHg, HCO3- 19, PaO2 50, SpO2 90% What would your next treatment priority be? A 70-year-old, 80 kg patient is intubated and being mechanically ventilated. Dopamine is infusing at 10 mcg/kg/min. Vital signs: BP 110/60, HR 110, RR 16 bpm assisted Ventilator settings: AC 16, Vt 550, PEEP 3, FiO2 0.6 ABG results: pH 7.34, PaCO2 50 mmHg, HCO3- 19, PaO2 50, SpO2 90% What would your next treatment priority be? Correct! Increase the FiO2 and PEEP Correct! Continue transporting with no additional interventions Give a lactated ringer bolus of 250 mL Wean the dopamine to 7.5mcg/kg/min B: Continue transporting with no additional interventions C: Give a lactated ringer bolus of 250 mL D: Wean the dopamine to 7.5mcg/kg/min

A: Increase the FiO2 and PEEP

Common clinical indications of ARDS include which of the following: A: PACWP of <18 mmHg B: unilateral infiltrates on CXR C: insidious onset D: PaO2 / FiO2 ratio of >300

A: PACWP of <18 mmHg ARDS is indicated by a PaO2 / FiO2 ratio of <200, bilateral infiltrates on CXR, an acute onset and PACWP <18 mmHg.

The most common diagnostic finding in acute respiratory deterioration is? A: PaCO2 > 50 mmHg B: PaO2 > 100 mmHg C: Epistaxis D: Pulmonary fibrosis

A: PaCO2 > 50 mmHg

What is a secondary complication to chronic obstructive pulmonary disease? A: Polycythemia B: Erythrocytopenia C: Thrombocythemia D: Leukocytopenia

A: Polycythemia

A patient involved in a 20 foot fall has the following vital signs: BP 70/30, HR 130, ETCO2 of 25 mmHg. What drug would the CCT provider prepare to administer during RSI? A: Push Dose Vasopressin and NS B: LR and Epinephrine IV infusion C: Push Dose Epinephrine and LR D: Neosynephrine IV infusion and NS

A: Push Dose Vasopressin and NS This patient scenario is perfect for push dose Vasopressin and IV fluid. Epinephrine would not be the optimal choice provided the potential head injury.

A patient with venous admixture will: A: respond to oxygen. B: will not respond to oxygen. C: respond to high pressure room air. D: respond to room air ventilation.

A: Respond to Oxygen A venous admixture will respond to oxygen. This is one of the easiest ways to determine if a patient has venous admixture.

What is the leading indirect cause of acute respiratory distress syndrome (ARDS)? A: Shock B: Pneumonia C: Heart failure D: Acute hypoxia

A: Shock

According to Boyle's Law, P1V1=P2VS when ___________________________ remains constant. A: temperature B: atmospheres C: mercury D: torr

A: Temperature = P2V2 when temperature remains constant. Remember as you increase in altitude, air pressure drops and gaseous volume expands.

After reviewing your patient's labs, you notice that their potassium level is 2.7 mEq/L. When looking at their ECG, what would you expect to find? A: U waves B: Increased PR interval C: ST segment elevation D: Peaked T waves

A: U waves

A patient with shortness of breath and a history of asthma presents with a WBC of 14, normal neutrophils, normal lymphocytes and an elevated eosinophil count. The patient is likely suffering from: A: an allergic reaction B: a normal finding C: a viral pneumonia D: a fungal pneumonia

A: an allergic reactionThe patient is suffering from an allergic reaction. An elevated WBC reflects a stress response, however the abnormal eosinophil count points us to the non-infectious cause - an allergic reaction.

A patient with chronic bronchitis will primarily compensate by: A: increasing blood flow through the pulmonary capillary B: increase the production mucous for bronchial lubrication C: increasing the diameter of the bronchial tree D: retaining additional CO2 to promote pulmonary vasoconstriction

A: increasing blood flow through the pulmonary capillary Remember that patients with chronic bronchitis have a primary issue in the airways; the pulmonary capillary bed is undamaged. Therefore, for compensation, these patient's will increase blood flow through the alveolar capillary membrane as well as produce additional RBCs to increase oxygen carrying capacity.

What are the steps to calculate expiratory time?

A: inspiratory flow B: Calculate Raw C: Raw/Flow L/cmH2O seconds.

A key assessment finding in a patient with pulsus paradoxus includes: A: present heart tones, but no correlating radial pulse B: present, palpable radial pulse, but absent heart tones C: absent radial pulse and absent heart tones D: present radial pulse and present heart tones

A: present heart tones, but no correlating radial pulse Pulsus paradoxus is present when the provider can auscultate heart tones, but can not detect a correlating radial pulse during the inspiratory phase of ventilation. This is directly related to hyperinflation and increased intrathoracic pressures.

A critical care transport provider knows that flicker vertigo is primarily caused by: A: sunlight passing through the rotors B: various position lights on the aircraft C: rapidly blinking during level flight D: excess radio chatter on takeoff

A: sunlight passing through the rotors Flicker vertigo is primarily caused by sunlight passing through the rotor blades. This can induce a sudden onset of vertigo and nausea.

A patient with a BMI of 46 has an open femur fracture and has a rapidly declining GCS. What is the preferred method for intubating this patient? A: video laryngoscopy B: direct laryngoscopy C: needle laryngoscopy D: visual laryngoscopy

A: video laryngoscopy This patient meets criteria for video laryngoscopy, primarily in extreme of sizes, according to the HEAVEN criteria - video laryngoscopy is the best method for this patient.

PaO2/FiO2 <200 points to?

ARDS

What does the A in GOLD mark stand for?

ASA Aspirin

What are the signs of hypermagnesemia?

Absent DTRs hypotension bradycardia heart block cardiac arrest respiratory depression

A patient found to be in a metabolic acidosis with high Oxoproline levels has likely ingested a toxic amount of __________________________?

Acetaminophen Remember that Acetaminophen overdoses cause excess accumulation of Oxoproline, a potent acid, leading to the metabolic acidosis.

Lactate production is the byproduct of what?

Aerobic and Anaerobic metabolism.

What is Barobariatrauma?

Acts like decompression sickness. Common in morbidly obese PT. Nitrogen Narcosis.

What are some causes of normal MCV (normocytic) and they are anemic with a low H/H.

Acute blood loss, Anemia of chronic disease

PaO2/FiO2 <300 points to?

Acute lung injury

How do you change the surface area in the surfactant?

Add PEEP

How can you correspond water pressure to altitude?

Adding about 14.7 PSI to each atmospheric stage

What is ATP?

Adenosine Triphosphate - ENERGY - is required for active transport.

Aerobic metabolism is dependent on what?

Adequate O2 delivery, Ability to carry O2, Ability to move O2, Ability to extract O2 to the cells

What is the purpose of push doese pressors for AAM?

Administration of intermittent push dose vasopressors to optimize the PT's hemodynamic status.

The A in DEATH acronym stands for what?

Alcohol

What are the contraindications for Atropine in the AAM (advanced airway management)

Allergy

What is the contraindications for norcuron?

Allergy to the drug components, unsecured airway.

What are the contraindicaitons for etomidate?

Allergy, Adrenal insufficiency, Sepsis. Can be dangerous for Hypotension.

What are the contraindications for Ketamine?

Allergy, HTN

Describe Pulmonary shunt.

Alveoli are perfused with blood as normal, but ventilation (The supply of oxygen) fails to supply the perfused regions.

What is Oxoproline?

An acid that is the byproduct of acetaminophen overdose.

You have a 68 year old female with the following CBC. She has a history of GI bleeds, hypertension, MI, and Asthma. What is probably going on? Hgb: 9.2 g/dL Hct: 27.2% RBC: 2.8 million/mcL MCV: 81 fL MCH: 25pg RDW: 13.2%

Anemia due to acute blood loss.

What are some causes of increased WBC count?

Anemia, Bone marrow problems, Severe stress, Tissue damage (burns)

What can cause increased platelets?

Anemia, Polycythemia.

At what part of the flight does Barobariatrauma occur?

Ascent

What is the treatment for pneumonia?

Antibiotics. Inhaled bronchiodilators Oxygen CPAP, ventilator support Fluid resuscitation Supportive measure Pulmonary toilet (

At what part of the flight does Barosinusitis occur?

Ascent

At what part of the flight does barodentalgia occur?

Ascent

What is pre-renal failure?

Anything that causes low volume to the kidney (BUN:Cr >20). burns, dehydration, hemmorrhage, sweating.

What is hyponatremia?

Anything with a sodium of <135 mEq/L

What is larson's maneuver?

Application of firm pressure to laryngospasm notch just behind the earlobe, applied bilaterally toward the skull base Pressure should be applied for 3-5 seconds then released for 5-10 seconds

What is Boyle's law?

As altitude increases the atmospheric pressure decreases and gas in an enclosed space will expand P-pressure V-volume P1 V1= P2 V2

When do you identify barotitus media?

As you descend back down you notice it.

A patient is at sea level (760 mmHg) and is on 30% O2 (FiO2 of 0.3). What is their partial pressure of oxygen at this altitude? A: 200 B: 228 C: 500 D: 90

B: 228 760 x 0.30 = 228 (partial pressure of oxygen at sea level) on 30% oxygen. Remember that normal PaO2 on an ABG is 80-100.

PaO2 will decrease by ____________ mmHg for every _____________ feet increase in altitude. A: 10 / 2,000 B: 5 / 1,000 C: 15 / 5,000 D: 4 / 3,000

B: 5 / 1,000

You are scuba diving in a local lake and descend to 132 ft below the surface. At this point in the descent, you are experiencing how many atmospheres? A: 4 ATM's B: 5 ATM's C: 6 ATM's D: 3 ATM's

B: 5 ATM's

You arrive at the bedside of a critically ill patient who is on a partial non-rebreather mask at 80%. Calculate this patient's bedside PaO2. A: 560 B: 510 C: 1,000 D: 1,100

B: 510 Remember that a bedside calculation of a patient's PaO2 is (700 x FiO2) - 50. For this patient, 700 x .80 = 560 - 50 = 510

An ARDS patient with a current SpO2 of 85% is being transferred. The current FiO2 via the mechanical ventilator is set at 50%. The current referring hospital's elevation is 500 ft. The pilot advises the highest altitude you'll be flying at will be 5,000 ft. Using the chart below, calculate the required FiO2 change needed based on the Desired FiO2 by Altitude Formula. A: 52% B: 58% C: 56% D: 54%

B: 58%

A patient who experienced a ground level fall after a syncopal episode demonstrates an RBC of 3 mil/mcl and an MCV of 90 fl/cell. These values are a result of: A: Acute anemia B: Acute blood loss C: Acute sickle cell crisis D: Acclimatization to altitude

B: Acute blood loss Given the scenario and blood counts, this patient is suffering from acute blood loss. The patient has a low RBC count and normal MCV.

You are transferring a patient who recently underwent a lower lobectomy due to lung cancer. He is a 50 pack/year smoker. He is currently on a ventilator with positive pressure ventilation. When auscultating his lung sounds, you notice diminished breath sounds in the right posterior lobe. What do you suspect is the cause of this? A: Developing pneumonia B: Atelectasis C: Tension pneumothorax D: Normal findings after a lobectomy

B: Atelectasis

Current evidence suggests that the most common ECG finding with pulmonary embolism is: A: McGinn-White sign B: RV straining pattern C: Left bundle branch block D: Deep Q waves in leads I and AVL

B: RV straining pattern The most common ECG finding indicative of a pulmonary embolism is an RV straining pattern given the hemodynamic changes. The McGinn-White sign is 7-8% accurate in diagnosing a PE, therefore not reliable.

When using a pressure-control mode of delivery, what can you expect? A: The ventilator triggers until a pre-set volume is reached. B: The ventilator triggers until a pre-set pressure limit is reached. C: The ventilator is pressure-regulated and volume-controlled. D: The ventilator delivers a consistent Vt while adhering to pressure limits.

B: The ventilator triggers until a pre-set pressure limit is reached.

Which of the following patients meets criteria for rapid sequence induction for intubation? A: a 93 year old male s/p fall with a baseline GCS of 7 B: a 15 year old female s/p MVC with no gag reflex C: a 49 year old male s/p GSW telling you he can taste blood every time he swallows D: a 7 year old with mild drooling and a high fever

B: a 15 year old female s/p MVC with no gag reflex Remember that one of the first indications for RSI is a patient that does not have an intact gag reflex. Although the others are sick and have potential for airway issues, the patient with no gag reflex is the priority.

The clinician knows that nitrogen narcosis most commonly occurs during ____________________________? A: descent phase of flight B: ascent phase of flight C: level phase of flight D: a rapid decompression

B: ascent phase of flight narcosis most commonly presents during ascent (air or sea). It is also dominantly seen in obese patients due to lipid storage of nitrogen

The provider has just intubated a patient for respiratory and oxygenation failure using succinylcholine and etomidate. The patient has appropriate ventilator settings but continues to bite on the tube resulting in high pressure alarms. You have administered multiple doses of Fentanyl, Ketamine and Versed with minimal effect. The next best action is to: A: confirm IV patency and administer additional Succinylcholine B: confirm IV patency and administer Rocuronium C: confirm IV patency and administer Cisatracurium D: confirm IV patency and administer Vecuronium

B: confirm IV patency and administer Rocuronium First, confirm the IV is patent; and secondly, add a medium-acting paralytic such as Rocuronium. Allowing the patient to have maximal therapy from the ventilator is essential and a paralytic added on top of sedation and analgesia would be a good way to achieve that.

Which of the following is true regarding CXR interpretation? A: Hyperinflation is when anterior rib 5 intersects the diaphragm at the mid-clavicular line B: the scapula are typically present in an AP view due to their posterior anatomical position C: the heart will appear larger than its actual size in a PA view D: the patient is not rotated if the spinous processes overlie the center of the sternum

B: the scapula are typically present in an AP view due to their posterior anatomical position Scapula can usually be seen in an AP view given the spread of the captured image and their posterior anatomical position

What is Trousseau's sign? Tra-so-s

BP cuff inflated and causes a carpal spasm.

Based on Henry's law how do we place the gas under pressure?

BVM or ventilator management application (Henry's law)

What does BE mean?

Base extra acids

What medications have a glycols in it?

Benzodiazepines such as diazepam (Valium), lorazepam (Ativan), barbiturates such as phenobarbital Anticonvulsives such as phenytoin (Dilantin) and nitroglycerin.

Triggering in most ventilators is based on what?

Bias flow. bias flow is used to clear Co2 out of circuit or is used as a flow sensor. The more the trigger is set to the more the pressure will need to be exerted for the ventilator to recognize a breath.

How does non-depolarizing paralytics work?

Bind to acetycholine receptors in a competitive, non-stimulatory manner, no receptor depolarization.

What is Chvostek sign?

Both are signs for hypocalcemia Chvostek sign- tapping angle of jaw elicits facial muscle contraction

What airway side affects does ketamine have?

Bronchidilaiton .

What will the bicarbonate be reflected as when evaluating a comprehensive metabolic panel?

CO2 When calculating anion gap, the Bicarbonate will be listed on the comprehensive metabolic panel as the CO2.

What is the COPD treatment?

Bronchodilators Anticholinergic drugs (ipatropium, atropine) Phosphodiesterase inhibitors Systemic and inhaled corticosteroids Mucolytic agents.

A patient who is volume overloaded would present with a serum osmolality of: A: 285 mOsm/kg B: 290 mOsm/kg C: 270 mOsm/kg D: 300 mOsm/kg

C: 270 mOsm/kg A patient who is volume overloaded has excess plasma and will be hemodiluted. This would lead to a hypoosmolar state which is reflected with a serum osmolarity of 270 mOsm/kg.

Identify the time of useful consciousness in an explosive decompression at an altitude of 43,000 ft? A: 12-16 seconds B: 8-12 seconds C: 3-5 seconds D: 5-8 seconds

C: 3-5 seconds

A patient with DKA is noted to have the following ABG: pH 7.20, PaCO2 32, HCO3- 15, PaO2 80. The patient's serum potassium is 4.0 mEq/L. You adjust the ventilator and the PaCO2 is now 42. What is your new, estimated potassium level?

C: 4.6 mEq/L Remember the 3 Golden Rules of ABG's. The PaCO2 increased by 10 mmHg, which dropped the pH by 0.08. For every 0.10 change in pH, the K+ moves 0.6 in the opposite direction; meaning the new K+ will be 4.6 mEq/L.

A 70 kg (IBW) patient is being mechanically ventilated with a rate of 20 bpm at 6 mL/kg. What is their alveolar minute ventilation? A: 8.6 L/min B: 8.0 L/min C: 5.4 L/min D: 8.3 L/min

C: 5.4 L/min Remember that minute ventilation = (Vt x RR) - Anatomical Deadspace. In this case, Vt is [(70 IBW kg x 6 ml/kg) x 20 bpm] . Anatomical deadpace = 1 mL for every pound of IBW x RR. The patient is 70 kg IBW, meaning his IBW in pounds is 150. (150 x 20) = 3,000 mL. There is 3,000 mL of anatomical dead space. Final math: (8.4L - 3.0L) = 5.4 L alveolar minute ventilation.

A patient is currently receiving a magnesium infusion due to hypomagnesemia (1.2 mEq/L initially). Upon assessment, which finding would alert you to immediately stop the infusion? A: Diarrhea B: An increase in the blood pressure of 15 mmHg C: Absent patellar reflexes D: Occasional PVCs on the ECG

C: Absent Patellar Reflexes

The main purpose of carbonic acid buffering system is to eliminate CO2 by breaking down _________ and ________ into hydrogen and bicarbonate

CO2 and H2O

Charles's law is best defined as: A: At a constant temperature, the pressure of a gas is inversely proportional to the volume of the gas B: The diffusion rate of a gas through a liquid medium is directly related to the solubility of the gas and is inversely proportional to the square root of its molecular weight C: At a constant pressure, the volume of a gas is very nearly proportional to its absolute temperature D: The amount of gas in a solution is proportional to the partial pressure of gas above the solution

C: At a constant pressure, the volume of a gas is very nearly proportional to its absolute temperature

A shift to the left on the oxyhemoglobin dissociation curve results in impaired dissociation of oxygen from hemoglobin. Which conditions would result in a left shift of the curve? A: pH of 7.10 B: Temperature of 103.0F C: Decreased levels of 2-3 DPG D: PaCO2 of 55mmHg

C: Decreased levels of 2-3 DPG

You have a 9-year-old female patient. Her current hematocrit (Hct) is 59%, serum Na+ is 158 mEq/L, and Cl- is 121 mEq/L What is the most likely cause of these findings? A: acute renal failure B: Normal findings in a pedi C: Dehydration D: Fluid overload

C: Dehydration.

You have administered 3 units of PRBCs. Your patient's initial Hgb & Hct (H&H) was 5 and 18. You would expect their H&H to increase to: A: Hgb 8 & Hct 25 B: Hgb 7 & Hct 24 C: Hgb 8 & Hct 27 D: Hgb 6 & Hct 21

C: Hgb 8 & Hct 27

With a respiratory rate of 40 bpm and an I:E ratio of 1:2, what would the inspiratory and expiratory times be? A: I = 0.1 sec / E = 0.2 sec B: I = 0.25 sec / E = 0.5 sec C: I = 0.5 sec / E = 1 sec D: I = 1.5 sec / E = 3.0 sec

C: I = 0.5 sec / E = 1 sec Remember that in order to calculate this, you must figure the RCT which is 1.5 seconds (60 sec/40 bpm). This then must be broken down into the 1:2 (I:E ratio). 1.5 seconds/(1+2) = 0.5 - which is the inspiratory phase. Simply double this for the expiratory phase (1.0

Your patient is the victim of a near-drowning incident that occurred at the lake earlier today. Initially, they were thought to be okay. However, after a few hours, they presented to the ED complaining of increasing shortness of breath. Upon assessment, they were found to be breathing at a rate of 42/min and crackles were auscultated in bilateral lower lobes as well as wheezing throughout. They were immediately placed on a NRB and ABGs obtained. Initial ABGs showed the following: pH 7.32, PaCO2 48mmHg, PaO2 46mmHg and HCO3- 20mEq/L You anticipate the next action to be? A: Administer high flow oxygen via NRB at 15 L/min B: Administer albuterol/atrovent via nebulizer C: Intubation and mechanical ventilation D: Assist with ventilations via BVM at 15 L/min

C: Intubation and mechanical ventilation

Which medication is recommended for induction in the high shock index or a low perfusion state? A: Versed B: Fentanyl C: Ketamine D: Etomidate

C: Ketamine

A patient with a known history of hypertension and adrenal insufficiency requires drug facilitated intubation. Which medication would the provider expect to administer? A: Etomidate B: Ketamine C: Midazolam D: Cardizem

C: Midazolam Remember that the contraindications for Ketamine and Etomidate respectively include hypertension (Ketamine) and adrenal insufficiency (Etomidate). The best option would be a benzodiazepine.

Which of the following hemodynamic parameters are consistent with a pulmonary embolism? A: CVP of 4 mmHg B: PAP of 18/10 C: PCWP of 4 D: RV of 18/5

C: PCWP of 4 Remember that an obstruction in the pulmonary arterial tract causes high right sided heart pressures (CVP, RV and PAP); however the wedge pressure will be low due to minimal blood flow to the left heart, leading to a reduction in cardiac output.

In volume controlled ventilation, it is more appropriate to monitor _____________. A: PIP and Vt B: PEEP and Pplat C: PIP, Pplat and static compliance D: Minute ventilation (VE)

C: PIP, Pplat and static compliance

Which of the following statements is true regarding tidal volume? A: starting tidal volume range is 4-6 mL/kg B: starting tidal volume range is 8-10 mL/kg C: starting tidal volume range is 6-8 mL/kg D: starting tidal volume range is 2-6 mL/kg

C: starting tidal volume range is 6-8 mL/kg The starting tidal volume is 6-8 mL/kg. Remember that lung protective strategy is 4-6 mL/kg

A lipid-protein liquid that is secreted by type-2 pneumocytes is called? A: glucocorticoid B: mineralcorticoid C: surfactant D: triglyceride

C: surfactant Surfactant is a lipid-protein liquid that is secreted by type-2 pneumocytes to help reduce surface tension within the alveoli.

What are some causes of hypercolemic state?

CHF, Kidney injuries.

What are the different buffer systems?

Carbonic acid-bicarbonate buffer Respiratory buffer kidney buffer.

What is the Fick Formula?

Cellular Uptake of O2.

What is ScvO2?

Central venous oxygen saturation (Ventralline cath= 5-8% higher)

What are Anions?

Chloride, Bicarbonate, Cyanide

A PT has a pH of 7.37. What are they?

Compensated acidosis. they are below 7.4 but within ranges of compensation.

What are some symptoms you might see in someone who is hypercalcemic?

Confusion, hypotonia/hyporeflexia, paresis, volume depretion, signs of pancreatitis, arrhythmias/shortened QT intervals, hypotension.

What is CK-MB?

Creatinine Kinase - Myocardial Banding. Byproduct of cell death specific to heart.

Which of the following patients would you anticipate being at the highest risk of developing hypernatremia? A: 56-year-old male with cancer of the lung and SIADH B: 73-year-old female with CHF taking loop diuretics C: 26-year-old male with acute diarrhea and vomiting D: 48-year-old female with bacterial pneumonia, fever, and diaphoresis

D: 48-year-old female with bacterial pneumonia, fever, and diaphoresis

A patient with an H/H of 4 g/dl and 18% has received two units of PRBCs. The provider estimates their new H/H to be? A: 8 gl/dL and 30% B: 7 g/dL and 22% C: 10 g/dL and 20% D: 6 g/dL and 24%

D: 6 g/dL and 24% Please remember that for every unit of PRBC administration the Hgb increases by 1 g/dl; and the Hct increases by 3%.

With a sensitivity set to 5 L/min on the Revel ventilator, how much flow volume would the patient have to change in order to trigger a breath? A: 1 mL/sec B: 75 mL/sec C: 100 mL/sec D: 83 mL/sec

D: 83mL/sec Remember that you first convert the 5L to 5,000 mL and then divide by 60 seconds; which would give you 83.3 mL/sec. That is how much the flow would have to change in order to trigger the ventilator to deliver a breath (when in AC mode).

A patient with ARDS becomes hypotensive. Vital signs are: BP 70/30, HR 100, PACWP 25 mmHg, intubated and sedated on APRV. The next best action is to: A: Administer an Normal Saline bolus B: Switch the ventilator mode to Volume SIMV C: Administer IV Meropenem D: Administer IV Levophed

D: Administer IV Levophed Provided the noted vital signs, especially the PACWP of 25 mmHg, the patient would benefit from a vasopressor. No additional IVF is needed given the left atrial hypertension.

A patient is intubated and continues to desaturate, with an increase in subcutaneous air noted. What would be the next best intervention for this patient? A: Needle decompression B: Decrease respiratory rate to 10 breaths per minute C: Chest tube insertion D: Advance ETT into right mainstem

D: Advance ETT into right mainstem

Which statement best describes a pulmonary embolus? A: Causes hypoventilation B: Causes an intrapulmonary shunt C: Causes a decrease in the amount of inspired oxygen D: Causes increased alveolar dead space

D: Causes increased alveolar dead space

For a reduction in Vte what is the DOPE pneumonic?

D: Disconection, dislodgement, O: Obstruction, suctioning? P: Pneumothorax E: Equipment

The "D" in the DEATH acronym stands for: A: Death B: Dehydration C: Debilitated D: Drugs

D: Drugs

Interpret the following blood gas: pH 7.21, PaCO2 80, HCO3- 12, PaO2 98

D: Mixed Disturbance This is a mixed disturbance due to the fact that both the respiratory parameter (PaCO2) and the metabolic parameter (HCO3-) is demonstrating an acidosis.

What class of medication is Rocuronium? A: Acetylcholinesterase agonist B: Depolarizing agent C: Agonist medication D: Non-depolarizing agent

D: Non-depolarizing agent

Your patient is demonstrating a sudden increase in PIP, with a normal Pplat. The most likely cause of this phenomenon would be? A: Tension pneumothorax B: Trendelenburg position C: Acute respiratory distress syndrome (ARDS) D: Patient coughing against the ventilator circuit

D: Patient coughing against the ventilator circuit

When using a pressure-control mode of delivery, what can you expect? A: The ventilator is pressure-regulated and volume-controlled. B: The ventilator triggers until a pre-set volume is reached. C: The ventilator delivers a consistent Vt while adhering to pressure limits. Correct Answer D: The ventilator triggers until a pre-set pressure limit is reached.

D: The ventilator triggers until a pre-set pressure limit is reached. Pressure delivery ventilation is the most gentle way to ventilate your patients. Always remember your patients are sick and have "baby" lungs. Pressure modes of ventilation are based on compliance and will only apply a pressure based on that compliance.

A patient would likely require PRBC transfusion at what Hgb level? A: Transfusion at <10 g/dL B: Transfusion at <8 g/dL C: Transfusion at <9 g/dL D: Transfusion at <7 g/dL

D: Transfusion at <7 g/dL

A patient is suffering from an acute asthma exacerbation. Which of the following situations would NOT require the patient to be intubated and mechanically ventilated? A: Hypoventilation secondary to muscle fatigue B: Uncompensated respiratory acidosis C: Decline in level of consciousnessv D: Uncompensated respiratory alkalosis

D: Uncompensated respiratory alkalosis

During level flight a patient experiences hypoxia. Using Dalton's gas law as a guide, the BEST action by the provider is to: A: tell the pilot to descend B: encourage the patient to breathe more rapidly C: listen to lung sounds D: place the patient on oxygen via nasal cannula

D: place the patient on oxygen via nasal cannula Dalton's law is about the the sum of all the partial pressures are equal to the overall pressure. By applying oxygen, you are increasing the partial pressure of oxygen which will help to correct the patient's hypoxia.

What are the main things that cause decreased plateletes?

DIC, Sepsis, HIT (heparin induced thrombocytopenia), Bone marrow failure, Certain medications, Certain viruses.

What are some causes of ketoacidosis?

DKA, Starvatoin, Chronic ETOH

What intubation technique is recommended for Hypoxemia PT's?

DL (Direct)

A patient on chemotherapy has reported feeling weak, tired and is short of breath on exertion. The likely cause of this patient's symptoms can be explained by:

Decreased RBC count. A PT undergoing Chemotherapy experiences bone marrow suppression, which will reduce the overall RBC count.

What is the affinity of a right shift in the oxyhemoglobin curve?

Decreased affinity. Your "picker outer" is broken so you tend to pick up duds and your duds are few and far between, but theyre duds so you no problem "dropping them off".

What is S1-Q3-T3?

Deep S wave in lead 1, Pathologic Q wave in lead 2, and a T wave inversion in lead 3

What is hypoxic hypoxia?

Deficiency in alveolar O2 exchange

What do elevated hematocrit point to ?

Dehydration.

At what part of the flight does Barotitis Media occur?

Descent

Pulse oximetry can reveal PaCO2? T or F?

False

Atmospheric Pressure not constant T or F?

False. Atmospheric pressure is constant

PaCO2 is usually lower than EtCO2? T or F?

False. EtCO2 is usually 3-5 points below PaCO2.

When a PT's low O2 alarm goes off you need to assume you need to start giving oxygen? T or F?

False. You do not beed to assume you need to start giving oxyen or increase the oxygen flow.

What is D-Dimer?

Fibrin degradation product that is elevated in the presence of a thrombus. Elevation can indicated possible DVT or PE but may also be elevated in patients s/p surgery and most hospitalized patients therefore it cannot be used to confirm DVT or PE if positive. If negative, can rule out DVT/PE

What is the key point to fix in a COPD/Asthma PT?

Fix the ventilation failure (failure to exhale) and optimize the exhalation process. This will in turn reduce airtrapping and allow more volume through the lungs over time. The hypoxia will then respond.

What type of PT's are found to be hypomagnesic?

ICU PT's

What is the route for Ketamine?

IV, IO, IM

What is the route to give fentanyl?

IV/IO

What route should you give atropine?

IV/IO

normal tidal volume is based on ideally what?

Ideal body weight

where does the carbonic acid buffering system opperate?

In the blood, lungs, and kidneys

were does vertigo occur?

In the middle ear.

What are Bands?

Immature neutrophils. If you see them on a CBC this points to an infection.

What is Electroneutrality?

In a aqueous solution, the sum of all the positively charged ions must equal the sum of all negatively charged ions.

What is methanol?

Ingestion of solvents (window washer fluid, De-icer fluid)

Why is etomidate dangerous for PT's with adrenal insuffficiency sepsis?

Inhibits cortisol production.

What are some causes of decreased RBC count?

Iron Deficiency, Blood loss, Bone marrow suppression, and Hemolysis.

What is intra-renal failure?

Its the damage that has occurred inside the kidney causing filtration issues due to: ->Glomerulonephritis ->Nephrotic syndrome ->Dye used in test such as heart cath and CT scan ->Drug (Aminogycosides) ->Malignant HTN (uncontrolled HTN) ->And DM causes severe vascular damage

You have a 68 year old male that is has respiratory depression with altered mentation. The PT's set of vitals follows RR: 36 shallow HR: 128 BP: 108/80 and a SpO2 of 88%. The decision to intubate was made. What induction agent would you use to sedate and why? Ketamine or Etomidate?

Ketamine. You do not use Etomidate due to the negative affects on the adrenal insufficiency.

What does the K in GOLD mark stand for?

Ketoacidosis.

What regulates potassium?

Kidneys

How do you calculate inspiratory flow?

L/cmH2O divided by 60 seconds

What does the L in GOLD mark stand for?

Lactate.

Lac of glucose or O2 cause an alteration in ATP production, The byproduct is??

Lactic acid

In anaerobic energy Pyruvic acid turns into what?

Lactic acid,

Elevated lactate points to what?

Lactic acidosis. Excessive lactic acid

At what SpO2 reading should we use a BVM?

Less than 93%

What produces surfactant?

Liquid protein that is secreted by Type II pneumocytes

What is the indications for cistracurium?

Long term paralysis.

what is oxidation?

Loss of electrons, oxygen gaining hyrogen ions

In metabolic alkalosis the PT will have abnormal values for K+, Na+, Mg++, and Ca++. What are these values?

Low K+, Na+ High Mg++, Ca++

What are the 4 L's of oxyhemoglobin Dissociation curve?

Low Temperature Low acid Low 2-3 DPG Low PaO2.

Low PaCO2 point to ________ acid?

Low acid.

How do you calculate corrected sodium?

Measured NA+ +[0.016 X (serum glucose-100)]

In V/Q Mismatch what does Q stand for?

Medical abbreviation for "flow"

A MCV of less than 80 is?

Microcytic

Whats the difference between mmHg and inHg?

Millimetres vs Inches.

How long does the respiratory buffer system take place?

Minute to minute

How does air present in a X-ray?

More dark.

When shifted to the right hemoglobin releases oxygen _________

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