CCP-FPC final prep 2.0
Why would you see D-lactate?
Propoline glycol toxcicity, Acetaminophen overdose, or chron's disease
What kind of "PT variables" affect pulse oximetry readings?
Pulse ox is less accurate when SpO2 values are below 70%, PT's with arrhythmias, hypotension, vasoconstriction.
How do you calculate Delivery of O2?
Q X CaO2 Q=Cardiac output CaO2= content of oxygen in the arterial blood.
How do we manage metabolic alkalosis?
Reduce GI suctioning: reduce NG OG suctioning Treat abnormal K+, Mg++, Na+, and Ca++ Low K+, Na++ High Mg++, Ca++ Treat underlying causes.
What is the oxyhemoglobin curve?
hemoglobin saturation and desaturation plotted on a chart
What is glycolysis?
the breakdown of glucose by enzymes, releasing energy and pyruvic acid.
What is partial pressure?
the pressure exerted by a particular gas in a mixture of gases
What is Charles law?
the relationship between temperature and volume are proportional at a constant atmospheric pressure. As the temperature goes up, gas volume expands. As the temperature goes down, volume decreases.
What is the Krebs Cycle?
the sequence of reactions by which most living cells generate energy during the process of aerobic respiration. It takes place in the mitochondria, consuming oxygen, producing carbon dioxide and water as waste products, and converting ADP to energy-rich ATP.
Water pressure
the weight of water pressing on an object
What are the 5 R's of the Bohr effect?
these are for the Right shift in Bohr effect. Raised Acid Raised CO2 Raised Temperature Raised 2-3 DPG Raised PaO2
What is polycythemia? Who is affected by it
too many red blood cells COPD PT's
How do you calculate MAP?
(2XDBP) + SBP/3
How do you calculate bedisde PaCO2?
(700 torr X FiO2)-50
At what altitude are you at risk for indifferent stage?
0-10,000 ft
What is a normal HCO3-?
22-26 remember HCO3- is metabolic.
What is a normal Barometric pressure at sea level?
29.92 inHg inches of Mercury
What is a normal Albumin level?
3.5-5 g/dL
What is a normal PaCO2?
35-45 mmHg Remember PaCO2 is respiratory.
Aerobic metabolism produces a total amount of ___________ ATP?
36
During Oxidative phosphorylaiton how many net ATP do you produce?
36
Hemoglobin is made up of what?
4 strands of amino acids
Flickers vertigo can cause seizures, What is the Hertz range of flickers vertigo?
4-20Hz
What is a normal chloride range?
95-105 mEq/L
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.
How do you calculate ATM's?
For every 33ft we ascend or descend we enter another ATM.
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
What kind of law is Dalton's law?
Gas law of partial pressure
As temperature goes up, gas volume does what?
Gas volume expands
Aeurobic metabolism of ATP required __________ and _______ and the byproducts are ________ and __________
Glucose and O2. CO2 and H20
The PT has a ETCO2 of 40mmHg. The Provider estimates taht the PaCO2 is?
Greater than 40.
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.
How do you treat Barobariatrauma?
High flow O2 that will cause nitrogen to diffuse.
How long does the kidney buffer system take place?
Hours to days
What causes a right shift on the oxyhemoglobin dissociation curve? A: Decreased levels of 2-3 DPG B: Alkalosis C: Hypothermia, D: Hyperthermia
Hyperthermia
What is the Bohr effect?
The Hemoglobin oxyen binding affinity is inversely related both to acidity and the concentration of carbon dioxide.
what is oxidation?
Loss of electrons, oxygen gaining hyrogen ions
What are the 4 L's of oxyhemoglobin Dissociation curve?
Low Temperature Low acid Low 2-3 DPG Low PaO2.
Whats the difference between mmHg and inHg?
Millimetres vs Inches.
How long does the respiratory buffer system take place?
Minute to minute
When shifted to the right hemoglobin releases oxygen _________
More readily.
What are the different buffer systems?
Carbonic acid-bicarbonate buffer Respiratory buffer kidney buffer.
What is the normal relationship between HCO3- and Carbonic acid?
20:1
What percentage of oxygen do we breath?
21%
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
How do you calculate Desired O2 per altitude?
%FiO2 X P1/P2 P1=current barometric pressure P2=New barometric pressure at altitude.
What is a normal BE?
-2 to +2
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 is the standard number for BSA?
1.7msquared devide product of O2 delivery by 1.7msquared.
At what altitude are you at risk for Compensatory stage?
10,000-15,000 ft
What is a normal sodium range?
135-145
What is the PSI at 0 feet? What atmospheric stage are you in?
14.7PSI at stage 1
At what height do you reach the disturbance stage?
15,000-20,000 ft
What is a normal Corrected anion gap?
16-20 Over that may point to metabolic acidosis
What are the Core points?
1: Atmospheric Pressure is constant 2: Proportional relationship with temperature and volume 3: For every 1000' ascended, the temperature will decrease 2o 4: For every 150 meters ascended, the temperature will decrease by 1o C
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.
How much ATP is produced in glycolysis?
2 ATP
What percentage of oxygen going to the tissue dissolves in plasma?
2-3%
At what altitude do you hit the critical stage?
20,000-25,000.
The average adult stomach holds how much liters of volume?
4L
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.
What is the average cardiac output for an adult?
5L/min
PaO2 will decrease by _______mmHg per 1000ft increase in altitude?
5mmHg
How much Co2 is produced after the Kreb cycle?
6 molecules
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
What is the normal PaO2 on an ABG?
80-100
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 surfactant?
A detergent like complex, reduces surface tension and helps keep the alveoli from collapsing.
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 medications have a glycols in it?
Benzodiazepines such as diazepam (Valium), lorazepam (Ativan), barbiturates such as phenobarbital Anticonvulsives such as phenytoin (Dilantin) and nitroglycerin.
What is Barobariatrauma?
Acts like decompression sickness. Common in morbidly obese PT. Nitrogen Narcosis.
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
Lactate production is the byproduct of what?
Aerobic and Anaerobic metabolism.
For every change in pH of 1.0 the K+ will change in ____________ in the ________ direction. A: 0.6 in the opposite direction B: 0.6 in the same direction C: 0.06 in the opposite direction D: 0.06 in the same direction
A: 0.6 in the opposite direction.
Interpret the following blood gas: pH 7.30, PaCO2 60, HCO3- 30, PaO2 98 A: Partially compensated respiratory acidosis B: Partially compensated metabolic acidosis C: Uncompensated metabolic alkalosis D: Compensated respiratory alkalosis.
A: Partially compensated respiratory acidosis.
Interpret the following blood gas: pH 7.50, PaCO2 12, HCO3- 25, PaO2 95 A: Uncompensated Respiratory alkalosis B: Uncompensated Respiratory Acidosis C: Compensated Metabolic Alkalosis D: Compensated Metabolic Acidosis?
A: Uncompensated Respiratory Alkalosis.
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
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.
What is V/Q mismatch?
An imbalance in the amount of O2 received in the alveoli and the amount of blood flowing through the alveolar capillaries
What is pre-renal failure?
Anything that causes low volume to the kidney (BUN:Cr >20). burns, dehydration, hemmorrhage, sweating.
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.
At what part of the flight does Barobariatrauma occur?
Ascent
For every 10mEq/L change in HCO3- the pH will change by __________ in the _________direction? A: 0.15 in the opposite direction B: 0.15 in the same direction. C: .25 in the opposite direction. D: .25 in the same direction.
B: 0.15 in the same direction
The primary purpose of the carbonic acid buffering system is to _______________ CO2. A: Produce B: Eliminate C: Off-gas D: Biotransform
B: Eliminate
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 is a normal ABG for a human?
pH (7.35-7.45) PaO2 (75-100 mmHg) PaCO2 (35-45 mmHg)
For every 10mmHg change in PaCO2 the pH will change __________in the ________ direction? A: 0.08 same direction B: 1.0 same direction. C: 0.08 opposite direction D: 1.0 opposite direction
C: 0.08 opposite direction
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? A: 3.4 mEq/L B: 2.7 mEq/L C: 4.0 mEq/L D: 2.8 mEq/L
C: 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.
What will the bicarbonate be reflected as when evaluating a comprehensive metabolic panel? A: Sodium B: Potassium C: CO2 D: Calcium
C: CO2 When calculating anion gap, the Bicarbonate will be listed on the comprehensive metabolic panel as the CO2.
The main purpose of carbonic acid buffering system is to eliminate CO2 by breaking down _________ and ________ into hydrogen and bicarbonate A: O2 and CO2 B: HCO3 and O2 C: CO2 and H20
C: CO2 and H2O
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
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? A: PaCO2 40mmHg B: PaCO2 20mmHg C: HCO3- of 17 mEq/L D: HCO3- of 27 mEq/L
C: HCO3- of 17 mEq/L To make this a partially compensated respiratory alkalosis the HCO3- would have to be less than 22 mEq/L.
In metabolic alkalosis the PT will have abnormal values for K+, Na+, Mg++, and Ca++. What are these values? A: High Mg++, Ca++ low K+, Na+ B: High K+, Mg++, Low Ca++, Na+ C: Low K+, Na+ High Mg++, Ca++ D: High Na+, Mg++ Low K+, Ca++
C: Low K+, Na+ High Mg++, Ca++
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
What is ScvO2?
Central venous oxygen saturation (Ventralline cath= 5-8% higher)
Identify the following ABG: pH 7.37, PaCO2 58, HCO3 23, PaO2 106, BE -2
Compensated Respiratory Acidosis.
A PT has a pH of 7.37. What are they?
Compensated acidosis. they are below 7.4 but within ranges of compensation.
What is D lactate?
D-lactic acidosis is an unusual form of lactic acidosis that can occur in patients with short bowel syndrome
A patient found to be in a metabolic acidosis with high Oxoproline levels has likely ingested a toxic amount of __________________________? A: Toxic Glycols B: Acetylsalicylic Acid C: Glucose D: Acetaminophen
D: Acetaminophen Remember that Acetaminophen overdoses cause excess accumulation of Oxoproline, a potent acid, leading to the metabolic acidosis.
Interpret the following blood gas: pH 7.21, PaCO2 80, HCO3- 12, PaO2 98 A: Compensated metabolic acidosis B: Partially compensated respiratory acidosis C: Uncompensated metabolic acidosis D: Mixed disturbance
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 are some causes of ketoacidosis?
DKA, Starvatoin, Chronic ETOH
What law is the gas law of partial pressure?
Dalton's law.
For every 1000 ft ascended temperature does what?
Decreased 2 degrees Cellcius
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 a strong ion difference?
Difference between sodium and chloride
In regards to the Stressors of flight What does D.E.A.T.H. stand for?
Drugs Exhaustion Alcohol Tobacco Hypoglycemia
Pulse oximetry can reveal PaCO2? T or F?
False
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 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.
where does the carbonic acid buffering system opperate?
In the blood, lungs, and kidneys
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 methanol?
Ingestion of solvents (window washer fluid, De-icer fluid)
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
Lac of glucose or O2 cause an alteration in ATP production, The byproduct is??
Lactic acid
What produces surfactant?
Liquid protein that is secreted by Type II pneumocytes
What kind of "Technical" variables affect the pulse oximetry accuracy?
Motion artifact, ambient light, dark nail polish, improper placed sensor, PT movement.
A PT has a ABG Demonstrating the following pH 7.09, PaCO2 60, HCO3- 10. How do they identify? A: Uncompensated Respiratory Acidosis B: Uncompensated Metabolic acidosis?
Neither, they are having a mixed disturbance
Are you aware of the indifferent stage of hypoxia?
No
What is a normal L-Lactate?
Normal lactate range is less than 2.3 mmol/L.
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 kind of PT's might have higher than normal Methemoglobinemia levels?
PT's nitrate or lidocaine therapy.
What is the 4,5,6 and 7,8,9 rule?
PaO2 40= SaO2 70 PaO2 50= SaO2 80 PaO2 60= SaO2 90
What is PaO2?
Partial pressure of oxygen dissolved in the blood
What is PAO2?
Partial pressure of oxygen in the alveoli
What is PO2?
Partial pressure of oxygen in the given environment.
While in the aircraft the PT becomes hypoxic Dalton's law is about the the sum of all the __________________ are equal to the overall pressure. By applying, _______________ you are increasing the partial pressure of oxygen which will help to correct the patient's hypoxia.
Partial pressure, Oxygen
Identify the following ABG: pH 7.28, PaCO2 20, HCO3 17, PaO2 80, Base Excess -8
Partially compensated metabolic acidosis.
What are the different types of renal failure?
Pre-renal, Intra-renal, and post-renal
How do you calculate Stroke volume?
Preload, Afterload, And contractility.
What is constant in charle's law?
Pressure
A PT with venous admixture will respond to what?
Respond to oxygen.
A multi-systems trauma patient with massive hemorrhage has an ABG of: pH 7.14, PaCO2 58, HCO3 18, PaO2 68, BE -9. What direction would the oxyhemoglobin curve move toward?
Right
Which shift is good for the PT? In regards to Oxyhemoglobin dissociation curve?
Right shift.
Oxygen delivery (DO2) is a product of what?
SaO2, Hgb, Cardiac output.
How long does the Carbonic acid-bicarbonate buffer system take place?
Second to second.
What is Barodentalgia?
Sharp pain in your jaw during ascent due to Inflamed pulp, gum abscess
What is the simplicity of Graham's law?
Simple law of diffusion. Remember the gases diffuse from a region of higher concentration to the lower concentration
What is SvO2?
The mixed venous oxygen saturation (pulmonary artery cath)
What is barosinutitis?
Sinus gland pressure increases as you ascent and you experience a massive pain
What are the signs of critical stage?
SpO2 at 60-70% Inability to remain upright, Jerking upper limbs, Seizures, Rapid unconsciousness, Coma and death.
What are the symptoms when someone is at the disturbance stage?
SpO2 of 70-80%, loss of senses: vision, touch, pain, hearing. CNS effects on memory, judgment, reliability, understanding. Psych loss of coordination, flight control, speech, handwriting. People start to hyperventilatie and are cyanotic.
When calculating a PT's oxygen consumption, the providers knows it is best to draw blood from the?
Subclavian triple lumen catheter.
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.
What is the altimeter setting (reading)?
The barometric pressure at a current location.
What is DO2?
The delivery of oxygen each minute.
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 L-Lactate?
The lactate that we build during glycolosis.
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 Fick's law?
The rate of diffusion of a gas across a permeable membrane is determined by the chemical nature of the membrane itself, the surface areas of the membrane, the partial pressure gradient of the gas across the membrane, and the thickness of the membrane.
What is Graham's law?
The rate of diffusion of a gas is inversely proportional to the square root of its molecular weight. This means that diffusion will happen at a faster rate if the gas is thinner and at a slower rate if the gas is heavier.
What is post-renal failure?
Things that stop fluid from leaving the kidneys
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.
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 CaO2?
Total content of oxygen bound to Hgb.
Hemoglobin may be fully saturated with dysfunctional strands, T or F?
True
A patient's ABG is pH 7.21, PaCO2 55 and HCO3- of 23. According to the first, middle and last name method, what is the first and last name of this blood gas?
Uncompensated Acidosis.
Identify the following ABG: pH 7.55, PaCO2 23, HCO3 25, PaO2 85
Uncompensated Respiratory Alkalosis.
What is Oxidative phosphorylation?
Uses energy released by the electron transport chain to power ATP synthesis.
When does 2-3 DPG form?
When RBC break down glucose to made adenosine triphosphate.
Explain the left shift for the oxygemoglobin dissociation curve?
You really like this person you are dating, but you're not secure in your relationship so you are reluctant to let them go. Easy "pick up" but poor "drop off"-- this is bad!!! high amounts of PRBC (packed red blood cells)
What is the uncorrected anion anion gap equation?
[Na - (Cl + HCO3)] uncorrected anion gap
What is the corrected anion gap calculation?
[Na-(Cl+HCO3)]+K
What is contractility?
ability to shorten forcibly when stimulated
Based on Henry's law how do we change the surface area?
add PEEP
What is acetylsalicylic acid?
apsirin -major NSAID due to wide range of effects
For every 150 meters ascend, temperature does what?
decreases by 1 degree celcius
How is Hgb measured?
g/dL Remember to convert dl to mL when convert/simplify
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.
The patient has the following ABG values and vital signs: pH 7.10, PaCO2 54mmHg, HCO3 24, PaO2 92, EtCO2 50 mmHg, SpO2 92%. Upon arrival at the receiving facility, your EtCO2 is reflecting 30 mmHg, what would your change in pH reflect?
pH= 7.26 remember for ever change in 10mmHg in EtCO2 you get a change in 0.08 change in pH in the opposite direction.
What is Albumin?
plasma protein
What are the CNS effects during the compensatory stage?
poor judgment, irritable, drowsiness, decreased coordination.
What is afterload?
resistance left ventricle must overcome to circulate blood
What is flicker vertigo?
• Flashes at 4-20 cycles per second (light flickering through the propeller or rotor) can cause nausea & vertigo. Turn light off. Turn aircraft away. Transfer controls.
