CFRN
In a pregnant woman, the HR typically increases by ___-___ beats per minute.
10-20
What is the Respiratory Rate scoring for revised trauma score?
10-29 = 4 >29 = 3 6-9 = 2 1-5 = 1 0 = 0
Conservatively, when correcting hyperglycemia try not to lower glucose more than ____ mg/dL per hour
100 *lowering too fast can cause a massive fluid shift, which could cause cerebral edema*
If you have a disabled ground ambulance how far in front and behind the ambulance must you have a warning device (cone, flare, etc.)?
100 feet (if obstructed by hill activate another warning device 500 feet away)
How many mLs are in a dL?
100 ml per decilitre
An auto-purge of helium for an IABP wills/should happen every ____ feet in ascent and every _____ feet in descent.
1000, 2000
A perfect chloride level is ____. One common reason for elevated chloride is receiving a lot of normal ____.
102, saline
Fetal bradycardia is defined as a heart rate <___ sustained for at least ___-___ minutes.
120, 5-10
What are the old and new emergency frequencies?
121.5 (old), 406 (new - 800 MHz system) *if asked on test which one pick 406
What is the normal range for sodium?
135-145 mEq/L (perfect 140)
Normal male hgb is ___-18, and normal female hgb level is __-16_.
14, 12
What is the typical blood pressure cutoff for HTN in pregnancy?
140/90
Accelerations in fetal heart rate is appx ___bpm for ___ seconds and are a sign of well being during labor.
15, 15
In ARDS patients, you may want to consider a lower driving pressure, for a goal of <___. To do this you will need to either lower the ___ ___, and/or increase the ____.
15, tidal volume, PEEP
What is a normal PA systolic pressure?
15-25 (think similar to right ventricular systolic pressure)
What is the average mL of anatomical dead space in an adult?
150 ml
What is a normal platelet level?
150,000-400,000
Quick math for calculating drop in ATMs until appx 5000/6000 feet altitude is that for every ____ increase in altitude, ATM goes down 5%.
1500 feet
What is the normal corrected anion gap?
16-20
What is the SBP goal in an intraventricular hemorrhage patient?
160
Fetal tachycardia is defined as a heart rate >___ sustained for at least ___-___ minutes.
160, 5-10 (>180 significant tachycardia, >200 likely a fetal anomaly/rhythm not necessarily related to fetal hypoxia)
An ambulance needs to have a minimum fuel capacity of ____ miles.
175
Stage of labor that begins with onset of contractions and ends with complete dilation of the cervix.
1st stage
How many ATP are produced per 1 molecule of glucose during glycolysis process?
2
Anaerobic metabolism only nets ___ ATP.
2 (no electron transport change as it doesn't require O2)
For every 1000' increase in altitude, how much will the temperature decrease?
2 degrees celsius (if in meters - 150 meters ascent = 1 degree celsius temp decrease)
For CAMTS certification aircraft must have a minimum of ___ oxygen sources, ____ suction sources, defibrillation capibilities, and ____ capnography.
2, 2, ETCO2
What ECG leads are affected by RCA occlusion?
2, 3, aVF
Diastolic filling is ____ of the MAP
2/3
At ___ weeks the fundal height should be at the umbilicus.
20
A P/F ratio of <___ is part of the definition of ARDS based on the American/European Consensus Conference.
200 (P/F ratio: PaO2 divided by FiO2) (Berlin criteria - 200-300= mild ARDS, moderate 100-200, severe <100 *all with PEEP 5+*)
Minimum CAMTS requirements for pilots include them having ____ total flight hours, ____ hours as PIC in which ____ hours have to be night PIC.
2000, 1000, 100
To help determine sinus tachycardia vs SVT take ___ minus patients ___, and also rule out the 3 Hs: ____, hypovolemia, ____
220-age hypoxia, hyperthermia
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?
228 (760 x 0.3)
What is the current goal for ETCO2 in a head injury patient?
30-40 (some places now going 35-40)
What is the max dose total of IVP labetalol?
300mg
For every decrease below sea level (going below water) of ___ feet is equal to additional ATM
33 (ex: 99 feet below water is 4 ATMs - using 1 ATM as your "zero")
For most patients, you will want to keep the PIP at ___ or less.
35 (certain types of patients, such as asthmatics may need higher PIPs)
At ___ weeks the fundal height should be at the xyphoid process.
36
During oxidate phosphorylation, how many net ATP are produced?
36 (gross 38 but 2 are used during krebs cycle to power it)
Stage of labor that begins after delivery of baby and ends after placental delivery.
3rd stage
List 2 causes of postpartum hemorrhage
4 Ts - tone (uterine atony), trauma, tissue, thrombosis
Fluid calculation formula for pediatrics: ___cc for each kg 0-10 ___cc for each kg 11 and above ___cc for each kg 21 and above
4, 2, 1 Ex: 26kg peds - 40cc, 20cc, 6cc for a total of 66 ml/hr
Normal WBC levels?
4,500-10,500
What is the range of a normal minute volume?
4-8 L/min (average infant to adult)
Normal cardiac output?
4-8L/min
In a neonate/newborn a blood sugar less than ____ is treatable. Use a bolus of D10 ___ml/kg.
40, 1
Normal hematocrit in males is ___-52%, and normal hematocrit in females is ___-47%.
42, 37
What ICS is the phlebostatic axis at?
4th/5th
For CAMTS, all pilots must have an airline transportation pilot certification with ___ years of hire.
5
How many gases make up atmospheric air?
5 (nitrogen being the most, oxygen second)
PaO2 will decrease by ____________ mmHg for every _____________ feet increase in altitude.
5/1000
CPP at ___ or less starts causing brain infarction
50
Pregnant women by term have approximately how much of an increase in circulating blood volume?
50% (however hgb does not increase proportionally so they will appear anemic on a cbc)
Postpartum hemorrhage is defined as >___ml of blood loss in vaginal delivery or >___ml in cesarean delivery.
500, 1000
Normal BUN?
6-23
Normal RBC levels for males is 4.7-___, and for females is 4.2-___.
6.1, 5.4
What is the low end MAP you want to achieve for permissive hypotension in a trauma patient?
60 (shoot for 60-65, may need higher if TBI also involved to make sure CPP is adequate)
Normal CPP range for adult and peds?
60-80 (strive for >70 in adults (think MAP 90 using ICP 20 as general guideline in TBI patient), >60 in peds)
What is the formula for normal minute ventilation in adults?
60ml/kg/min (peds a little more) (when ventilated need to use more to account for dead space - use 100ml/kg/min)
What is the formula to calculate a minimum/low end "normal" systolic BP for pediatrics?
70 + (2 x age) (< than = hypotension)
What is 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 torr (380 x 0.21)
What is a normal pulmonary capillary wedge pressure?
8-12mmHg
What is a normal PA diastolic pressure?
8-15
Normal calcium levels?
8.8-10.4
Normal paO2 on ABG?
80-100 (partial pressure of oxygen or amount of oxygen measured/available in arterial blood)
Normal MCV range
80-95 *mean corpuscular volume (size of RBC) 80-95 (normocytic), >95 macrocytic, <80 microcytic
What are day FAA minimums for a local non-mountainous area?
800' - 2 miles
What are day FAA minimums for local mountainous areas?
800' - 3 miles
What is the formula to calculate a normal BP for pediatrics?
90 + (2 x age) (in children >1 yo)
What is the max dose for tPAfor ischemic stroke?
90mg
What is a normal Cl- level?
95-105 (perfect 102)
Normal Troponin 1?
<0.04 ng/mL
What the is UO goal during fluid resuscitation for a pediatric patient <10kg for end organ perfusion, and for a pediatric patient >10kg?
<10kg: 2mL/kg/hr >10kg: 1mL/kg/hr
An intravenous glycoproten IIB/IIIA platelet inhibitor used in ACS/MI (like a super ASA)
Aggrastat
Drugs that bind with receptors and mimic the true intrinsic action of the receptors
Agonists ex: epi, norepi
The first line therapy for HHNK is what?
Agressive IVF replacement (then consider potassium replacement and insulin administration)
You are transporting a patient on a ventilator with a Vt setting of 500mL. Over time you notice Vte dropping more and more, eventually significantly. What is likely happening?
Air trapping (Patient needs more time to exhale/i:e ratio not set correctly for patient, etc.)
A shark fin waveform on capnography is consistent with what disease process?
COPD (due to resistance to expiration)
What is the dominant extracellular anion?
Cl-
List 2 common anions.
Cl-, HCO3-, CN- (cyanide)
What is the DOPE mnemonic?
D - Displacement/dislodgement O - Obstruction: kinks/secretions P - Pneumothorax: high Pplats? (>30? consider) E - Equipment failure: pt detached? vent stop working?
What gas law states the sum of the partial pressure in a mixture of gases will equal the total pressure?
Dalton's law
What medication is used to treat malignant hyperthermia?
Dantrolene Sodium
If you identify pathological left axis deviation, what things must you look at to determine cause/rule out?
*LBBB? (already determined when looking at V1 QRS length first step) *LVH *Inferior wall MI *Paced rhythm *Left anterior fascicular block (aka left anterior hemi block)
What are the 3 qSOFA criteria?
*used for sepsis screening Respiratory rate 22, altered mentation - GCS <15, SBP 100mmHg or less (Some places also adding ETCO2 <25 with initial lactate >4 to help better screen)
What are the 3 generalized categories for hyponatremia?
*volume depletion (burns, vomiting, diuretics, etc.) *volume overload (kidney injury/failure, CHF, *loss of water (biggest cause - SIADH - causing body to hold onto water)
What are the 3 generalized categories for hypernatremia?
*volume depletion (sweating, diarrhea) *urine sodium will be <10 *volume overload (too much NS, cushings, too much NaHCO3- like a cardiac arrest) *urine sodium will be >20 *loss of water (huge loss in volume such as DI)
Right axis deviation is from ____ to ____ degrees and is only normal in which population?
+31 to +180, newborn babies (high pressure right side on birth)
Normal axis deviation is between ___ and ___ degrees
0 and +90
Normal ICP range?
0-15 mmHg
A normal diastolic right ventricular pressure is ___-___, and a normal systolic right ventricular pressure is ___-___.
0-5 (relaxation, think similar to CVP), 20-30 (ejection) (this waveform looks almost like Vtach, measured during insertion)
A pathologic Q wave from prior cardiac muscle death will be >___ seconds in width, >___mm in depth, and >____% of the R wave height.
0.04 seconds, 2mm, 25% *Physiologic Q waves will be opposite these parameters. (<0.04 seconds, <2mm, <25%)
For every 10 mEq of potassium replacement how much should it raise the K+ level?
0.1 mEq/L
For every 10mEq/L change in HCO3-, the pH will change by ___ in the same direction.
0.15
What is the normal QRS duration?
0.4-0.12 (anything greater indicates BBB)
What is the UO goal during fluid resuscitation for an adult without rhabdo for end organ perfusion?
0.5-1mL/kg/hr (1-2mL/kg/hr if rhabdo)
For every change in pH of 0.10, the K+ will change by ___ in the opposite direction.
0.6
What is a normal Cr level?
0.6-1.4
Anything over ___ is a high shock index, indicating a higher mortality potential
0.9
How many atmospheres (or ATMs) are at sea level?
1 atmosphere/ATM at sea level
For every unit of PRBCs administered, Hgb should increase by appx ___, and Hct should increase by approximately ____.
1 g/dL, 3%
On fetal monitoring strips, each thick line to thick line is how long?
1 minute (every big box - thin line to thin line - is 10 seconds)
What are the four components of electrical injuries?
1) "hidden injury" (injury from the electrical current) 2) injury from arcing 3) flash burn (anything ignite? heated gases inhaled?) 4) trauma from intense muscle spasms from "lock on" or potential fall/secondary trauma when it releases
A hemorrhage from the circle of willis/its branches is what type of bleed?
Subarachnoid
Hemorrhage that occurs between the brain and pia mater
Subarachnoid
What type of head bleed occurs between the dura mater and the arachnoid membrane?
Subdural
What does the pediatric acronym STABLE stand for?
Sugar, temperature, airway, blood pressure, lab values, emotional support
Chvostek's sign
Tap on Cheek, facial spasm when Cheek is tapped (hypocalcemia)
Congenital heart defect consisting of a large VSD, stenotic pulmonary valve, right ventricular hypertrophy, and rightward displacement of the aorta
Tetralogy of Fallot
List 2 management considerations for SIADH
Fluid restriction, Lasix (1mg/kg), raising Na 0.5 mEq/L an hour, hypertonic solution 1-2 ml/kg/hr if Na <105, reverse underlying cause
What is Newton's third law?
For every action there is an equal and opposite reaction
What is Newton's second law?
Force = mass x acceleration
A cell phone is an example of a ___ ___ radio system. It can transmit and receive simultaneously.
Full duplex
List 3 things to consider in management of postpartum hemorrhage
Fundal massage, blood products, TXA, fluid boluses, oxytocin, methergine (smooth muscle constrictor), cytotec, bimanual uterine compression, O2
What are the 3 components of revised trauma score?
GCS, SBP, Resp Rate
What is the GCS scoring for revised trauma score?
GCS: 13-15 = 4 9-12 = 3 6-8 = 2 4-5 = 1 3 = 0
What is Graham's gas law?
Gases diffuse from a region of higher concentration (pressure) to lower concentration (pressure) until equilibrium is reached.
Which gas law states the following: At a given mass and constant volume of gas, the pressure exerted on the sides of its container is directly proportional to its absolutely temperature.
Gay-Lusaac's law
What does on O2 challenge look like for a newborn/neonate?
Give O2 for 5 minutes, if not improving take oxygen off and assume congenital heart defect (which you likely dont want to give oxygen to)
What is axis deviation?
Gives you a general idea of the movement of electrical activity through the heart (ex: normal SA node towards Apex of heart)
___________ is the starting molecule for glycolysis
Glycogen
Gold Mark Acronym for Metabolic Acidosis Identification/Causes: G____ Oxoproline L-______ D-Lactate Methanol ASA R_____ Failure K_____acidosis
Glycols (ethylene glycol, propylene glycol) Oyxoproline (byproduct of tylenol OD) L-Lactate (lactate production from glycolysis, may also be from something like a metformin OD) D-Lactate (propylene glycol OD, tylenol OD, short bowel syndrome - infection in bowel) (specialty lab) Methanol (ingestion - window washer fluid, solvents) ASA (aspirin overdose/salicylates - will get tachypnic and febrile) Renal Failure (pre/intra/post renal) Ketoacidosis (DKA, Chronic ETOH, Starvation)
The kidney buffering system works by excreting ____ and ___ ions as needed, and can also make new ___ as needed.
HCO3, H (hydrogen), HCO3 (bicarb)
The % of volume made up of RBCs
Hematocrit
_____ carries appx 97-98% of oxygen in the body, and ___ carries appx 2-3%.
Hemoglobin, plasma
A patient suffering from decompression sickness is an example of which gas law?
Henry's
When administering high concentrations of oxygen to alleviate hypoxic hypoxia, you are altering which component of which gas law?
Henry's (and the solubility of oxygen diffusion into the solution - blood)
What gas law states that the amount of gas dissolved in a solution is directly proportional to the pressure of the gas on the surface of the solution?
Henry's law (think if you turn up FiO2 and there is more partial pressure of oxygen, more will be dissolved Into the solution - or think pop can, CO2 under pressure in can escapes proportionately when can is opened and pressure released)
How is nitrogen narcosis from barobariatrauma treated?
High flow O2 (preferably appx 15 minutes before flight if concerned this may present - morbidly obese, significant altitude changes)
What is the typical first line medication used in pregnancy induced hypertension?
Hydralazine
After carbonic acid (H2CO3) is formed, it wants to split apart, it breaks apart to create __ + ___
Hydrogen and bicarb (H + HCO3) (how we maintain consisten pH in homeostasis)
As pH becomes more acidotic, ___ ions shift into the cell causing ___ to be shifted out of the cell to maintain neutrality.
Hydrogen, Potassium
List 3 s/s of thyroid storm
Hyperthermia, tachycardia or afib, diaphoresis, confusion, n/v/d, tremulousness & delirium
List 2 reasons for decrease in pulmonary artery pressure
Hypovolemia (low preload coming to R side - meaning low preload coming to L side) Vasodilation Over-dampened waveform (not truly a decrease in PAP)
List 2 causes of elevated Cr
Hypovolemia, low GFR, poor creatinine clearance (kidney injury, kidney failure, excess muscle breakdown, etc.)
To ventilate a patient at a targeted pressure, the additive combination of ___ and ___ should equal your targeted pressure.
Inspiratory pressure and PEEP (ex: Target PIP of 30: Pinsp 20, PEEP 10)
List 3 potential signs of HELLP syndrome
RUQ pain, epigastric pain, headache, nausea, myalgia, DBP >100 (labs increased ALT/AST, Platelets typically <100,000)
List 4 signs and symptoms of an acetaminophen overdose
RUQ pain, rise in serum transaminase, increased liver enzymes, increased serum bilirubin, oliguria (<<24-72 hours); jaundice, tender hepatic edge, coagulopathy/DIC, hepatic enecphalopathy, death due to fulminate hepatic necrosis (<<72-96 hours) (also n/v, anorexia, tachycardia, hypotension)
How do you determine a right ventricular pressure waveform vs a pulmonary artery waveform?
RVP looks a little more lengthened and similar to V-tach with an anacrotic notch (notch on L side of waveform); PAP waveform shorter with dicrotic notch (notch on R side of waveform for closure of pulmonic valve)
What is the formula to calculate MAP?
MAP = [(DBPx2) + SBP]/3
A type of WBC that is phagocytic and elevates towards end of infection/injury - clean up crew.
Monocytes
An ECG concern identified by tall symmetrical T-waves, absence of ST elevation in precordial leads, absence or minimal (0.5-1mm) in aVR, upsloping ST segment depression >1mm, and normal ST morphology, can help identify insufficient left main flow
De Winters T Waves
Placental attachment over the opening of the cervix that is associated with *painless* bright red bleeding
Placenta Previa
Premature separation of placenta from wall of uterus
Placental abruption
A ventilator measurement that tells how much pressure is being exerted against the aveoli
Plateau pressure (or Pplat) *for a true plateau pressure has to be given with a volume breath, not pressure breath
To determine a bifascicular block you must have both a ____ and _____
RBBB and left hemiblock
The amount of pressure needed to open the airways, difference between plateau pressure and PEEP
Driving pressure (this is ONLY applied on ARDS patient) (conceptually it is the critical opening pressure of the airways)
What does the DEATH acronym stand for in regards to stressors of flight?
Drugs, Exhaustion, Alcohol, Tobacco, Hypoglycemia
List 2 types of triggers for IABP therapy
ECG (most common), ABP, internal pressure (used only in hospital usually in cardiac OR), or pacer (has to be 100% paced)
A common cause of low Mg++ is ____ imbalance.
Electrolyte (especially hypokalemia, hypocalcemia)
Hypotonic solutions cause H2O to ___ the cells
Enter
Type of white blood cell that primarily increases in state of allergic reaction.
Eosinophils (also in asthma patients, parasite reactions)
A concave appearing head bleed on a CT scan is always what type of bleed?
Epidural
A beta 1 adrenergic antagonist drug that has a rapid onset and short half life, good for use in AAAs.
Esmolol
When the IABP timing waveform shows a plateauing followed by a V shape, as well as possibly having no difference between assisted and unassisted diastolic pressures (or unassisted may be lower than assisted), what is your concern?
late deflation
When the IABP timing waveform has an exposed dicrotic notch, what is your concern?
late inflation (IAB inflating markedly after aortic valve closure (dicrotic notch)) *only real physiologic effect is sub-optimal perfusion of coronary arteries
1, aVL, V5, V6 have 2 or more ECG lead changes - what type of MI?
lateral wall
What type of oxyhemoglobin shift do you have if oxygen and hemoglobin have a high affinity for one another and hgb does not want to release O2 stores?
left
-31 to -90 degrees is defined as ____ axis ____ deviation
left axis pathological deviation
What two main coronary arteries branch off the left main coronary artery?
left circumflex, left anterior descending
Pregnant woman may need to be placed into what position to help displace the gravid uterus off the IVC and aorta?
left lateral
The positioning of the IABP should be approximately 1 to 2 cm below the origin of the ___ ____ artery, and above the ____ arteries.
left subclavian, renal
If calcium is high, your phosphorous will be ___.
low - and vice versa
What is the MCH?
mean corpuscular hemoglobin *the amount of hgb per RBC
What does the ending -remia mean?
measured in the blood stream *ex: hyponatREMIA
The loss in volume during a volume breath in the vent circuit based on expansion
mechanical deadspace
histotoxic hypoxia
metabolic poisons such as cyanide prevent the tissues from using oxygen delivered to them (ETOH or CO poisoning could also do this)
An epidural hematoma is typically caused by bleeding from what artery?
middle meningeal
The two heart valves responsible for letting blood into the ventricles that open/close in tandum
mitral valve and tricuspid valve
Barobariatrauma is more common in what type of population of patients?
morbidly obese
When there is a "right shift" on the oxygemoglobin dissociation curve, the body is offloading ____ oxygen into the blood stream.
more
In barobariatrauma, according to boyles law, as altitude increases and atmospheric pressure drops - the drop causes ____ to be displaced off of phospholipids and ____ narcosis can occur.
nitrogen, nitrogen
Umbilical cord around neck at time of baby delivery
nuchal cord *may see variable decelerations with nuchal cord*
List 3 potential causes of fetal bradycardia
prolonged cord compression, cord prolapse, tetanic/sustained uterine contractions, epidural/spinal anesthesia, maternal seizures, vigorous vaginal examination (leading to arterial vasospasm within cord), transverse presentations, >40week fetus
What is the scoring for verbal response on the glasgow coma scale?
oriented=5 confused=4 inappropriate words=3 incomprehensible sounds=2 none=1
anaerobic metabolism does not require ____
oxygen
If your patient has truncus arteriosis, transposition of the great vessels, tetralogy of fallot, total anomalous pulmonary venous return, coarctation of aorta, hypoplastic left heart, or tricuspid atresia be sure to maintain PDA patency by not giving ____ therapy and starting ____ medication therapy.
oxygen (PPV RA still ok - O2 can speed up process of closing PDA which needs to remain open), prostaglandin (cyanotic heart defects)
What is barometric pressure?
The combined weight of all atmospheric gases creating a force upon the surface of the earth.
Hemoglobin carries ___ out to the body and ___ back to the lungs as carboxyhemoglobin.
oxygen, CO2
List 3 s/s of snake envenomation
pain, muscle fasciculations, hypotension, petechiae, coagulopathies, diaphoresis or chills, parasthesia, n/v *respiratory depression & dysphagia (with coral snake bites)
Patients with a severe anterior MI can infarct what type of muscles that help control the valves?
papillary muscles -if mitral valve is affected by an infarcted papillary muscle can cause regurg, flash pulmonary edema, cardiogenic shock
List 3 signs of hyperkalemia.
parasthesias, generalized fatigue/weakness, metabolic acidosis, paralysis, palpitations, bradycardia, ectopy, new onset 2nd or 3rd degree heart blocks, diminished deep tendon reflexes, edema, peaked T waves
During phosphorylation, ADP gains one more ____ bond, creating ____.
phosphorous, ATP (the 3rd phosphorous bond is what the cell pulls off for energy source)
What is the antidote for anticholinergics?
physostigmine
What type of US snake bite causes immediate symptoms?
pit viper (coral snake bite s/s typically develop over appx 6 hours)
What are the two types of poisonous snakes within the US?
pit vipers and coral snakes
Where is the tricuspid valve located?
The tricuspid valve is located between the right atrium and right ventricle.
You have ST depression in V2, V3, and V4 either with or without an associated inferior wall MI, what type of other MI should you be suspicious of?
posterior wall (can do V7, V8 V9 ECG to help determine)
What makes up stroke volume?
preload, afterload, contractility
If you have correct lead placement, what should aVR look like?
primary QS wave (primary R wave check leads or could be another issue such as Vtach)
What causes the capillary leaking in sepsis?
proinflammatory mediators and cytokines that in large amounts start damaging the endothelial lining, leading to leaking from the vessels
What are normal right ventricular diastolic pressures and normal diastolic pulmonary artery pressures?
right ventricular diastolic: 0-5 pulmonary artery diastolic: 8-15
What does a V4R 12 lead help you identify?
right ventricular infarction (98-99% accurate for identification)
3 components you want to have in a chest xray to make sure to get a good read are ____, inspiration, and _____.
rotation, penetration
A period of time from the onset of a decompression until a person is unable to effectively or adequately perform duties due to an insufficient supply of oxygen.
Time of useful consciousness
What is the main concern with a brown recluse spider bite?
Tissue Necrosis (cytotoxic and hemolytic venom)
What is tricuspid atresia?
Tricuspid atresia is complete failure of the tricuspid valve to develop, leading to under-developed R ventricle. There is no communication from the R atrium to the R ventricle. Blood flows through an ASD or a patent foramen ovale to the left side of the heart and through a VSD to the R ventricle and out to the lungs. Complete mixing of unoxygenated and oxygenated blood = cyanosis, tachycardia and dyspnea.
T/F - In larger, taller individuals, a benign physiologic left axis deviation of -1 to -30 may occur.
True
T/F: Aerobic metabolism requires oxygen
True
T/F: Boots or sturdy shoes are a mandatory part of safety equipment for a flight clinican.
True
T/F: Bronchodilators help reduce mucus secretions.
True
T/F: If breech presentation and vaginal delivery, once shoulders are delivered rotate baby so back is anterior and apply downward pressure.
True
T/F: Subdural hematomas are typically venous in nature.
True
T/F: The altimeter setting is your barometric pressure.
True
T/F: The carbonic acid-bicarbonate buffering system is a second by second buffering system of our body metabolizing CO2.
True
T/F: Viruses tend to cause a decrease in WBC count.
True
T/F: When calculating burn BSA only calculate 2nd and 3rd degree burns.
True
T/F: A corrected anion gap can be an earlier indication of metabolic acidosis than an ABG
True (could also reflect an uncompensated respiratory alkalosis that hasn't progressed to metabolic yet)
T/F: Subdural hematomas will have more of a wavy appearance due to blood following the contours of the brain
True (Epidural will not have the wavy line appearance due to the dura being thick and blood can't follow the contours)
T/F: Patients with aspirin overdoses start in a respiratory alkalosis early on but progressively evolve to a metabolic acidosis
True (potassium loss from kidneys excreting K and bicarb, dehydration, helping to cause the progression)
T/F: Betahydroxybutarate is one of the earliest signs of ketone production.
True *Also one of the quickest things to trend to see if patient is getting better*
T/F: Early decelerations mirror contractions and are a common normal labor finding caused by vagal stimulation when the babies head is compressed during labor.
True *They have a slow onset, shallow dip in heart rate, return to baseline at end of contraction*
You must put patient in 1:2 (or higher - 1:3, ,etc.) IABP frequency timing to be able to evaluate assisted vs unassisted pressures.
True *cannot be 1:1 timing as every beat is assisted in 1:1
T/F: Alkaline substances tend to have more continued burns while acid substances tend to be shorter lasting.
True acids - Hydrogen ions cause majority of effects, alkalines - hydroxide ions cause majority of effects
T/F: In an explosive decompression above 40,000 feet time of useful consciousness will be less than 10 seconds.
True (*test tip pick shortest amount of time answer*)
T/F: The one time CVP doesn't mimic PCWP is during right sided heart failure.
True (CVP is high because of fluid back up from RV to RA, but right heart cant eject well into left side causing PCWP to be low)
T/F: In a left shift the SpO2 will be high, but PaO2 will be low
True (Hgb has high affinity to O2 and doesn't want to offload stores - so it is saturated (SpO2) but not actually offloading to the bloodstream)
T/F: If a patient is hypocalcemic that will very likely also be hypomagnesemic.
True (and vice versa)
T/F: If using a calcium channel blocker it should not be used in conjunction with magnesium sulfate.
True (consider pregnancy hypertension state where both may be being considered - both block intracellular calcium channels thereby decreasing smooth muscle contractility - concern of oversuppression and cardiac suppression)
T/F: Corrected sodium measurements should be used in DKA patients
True (not focusing on sodium state as once DKA state is being corrected sodium will come back up to normal, very diluted)
T/F: Chronic COPD patients tend to be hypercarbic and hypoxemic on ABGs.
True (think 50:50 club - PaCO2 >50, PaO2 <50)
T/F: Succinylcholine and epinephrine are two medications that burn the bodies oxygen supply quicker leading to potentially quicker desaturations.
True (think RSI scenario)
T/F: Atmospheric pressure and barometric pressure are essentially the same thing, just using a different unit of measure.
True (think measuring same item in inches and then measuring it in cm)
T/F: Barobariatrauma acts like a decompression sickness, such as a scuba diver who rapidly ascends.
True (would also be seen on ascent phase of flight)
T/F: A patient with uterine rupture needs to get to the OR within 10-30 minutes to reduce morbidity/mortality.
True - also consider blood products, fluids, oxygen, and oxytocin
T/F: ARDS is a secondary disease process/syndrome
True - always secondary to an underlying cause (direct lung injury ex: pneumonia, near-drowning, pulmonary contusion. Indirect lung injury ex: sepsis, CABG, drug overdose)
T/F: A common cause of high Mg++ levels is renal failure.
True - cleared by kidneys
T/F: A low specific gravity indicates a dilutional state, and a high specific gravity indicates a hemoconcentrated state.
True - dilutional state (peeing a lot, not secreting ADH ex: DI); hemoconcentrated state (not peeing, secreting ADH ex: SIADH)
T/F: during a right shift the patients SpO2 will be lower, but their PaO2 will be higher
True - hemoglobin molecules aren't as saturated with O2 (SpO2) but more O2 is being offloaded into bloodstream (hgb low affinity to O2 during right shift)
T/F: A severely hyperglycemic patient will often have a falsely low sodium level.
True - hyperosmolic state causing shifting leading to falsely low levels -usually DKA
T/F: Be cautious of giving D5W to patients with hyponatremia
True - isotonic in container, but body uses up dextrose quickly leaving essentially free water/hypotonic solution
T/F: Suctioning prophylactically in a neonate/newborn is no longer standard of care.
True - meconium staining would be indicator for suctioning
T/F: All lab values are a measure of what is in the extracellular volume.
True - no way to measure intracellular
T/F: Intraventricular hemorrhages are typically secondary
True - often an extension of another bleed (subarachnoid, parenchymal) *can be primary - trauma (shearing forces), aneurysm, vascular malformation
T/F: Decreased Hct levels are often due to overhydration.
True - overhydration, SIADH (also due to anemia)
T/F: You can cause an osmotic demyelination by raising Na+ too quickly.
True - raise 8-10 mEq/day *often irreversible/fatal
T/F: High lateral wall MIs are often missed.
True - usually very subtle ST elevation **if you see reciprocal changes in lead III, stop and really analyze lead 1 and aVL**
Measurement of concentration of the urine, ration of urine density and water density
Urine Specific Gravity
What makes up cardiac output?
stroke volume and heart rate
What medication is malignant hyperthermia most commonly associated with (for cause)?
succinylcholine
For ATP production, the ____ nervous system stimulates ___ 2 receptors, which then cause glycolosis to create more ATP.
sympathetic, beta
A left posterior hemiblock is fairly rare and indicative of global heart disease, why is this?
that area is supplied by both LAD and right posterior descending - **very sick heart**
Why do you use a particular syringe with the balloon port on a PA catheter?
the balloon only takes a very small amount of air (1-1.5ml), so if you use a big syringe and it ruptures, the plastic balloon pieces can get into the body
What does augmentation mean for IABP therapy?
the level of augmentation means how full the balloon is going to be to help assist patient (ex: if a 40cc balloon gets 40cc during inflation, they are fully augmented) - for weaning IABP decrease augmentation
what is a ventricular septal defect?
VSD is an abnormal opening between the right and left ventricles. It can cause more blood to go into left ventricle than usual, stretching it and putting pressure on the mitral valve, leading to a CHF type of clinical scenario
You are monitoring a fetal heart rate and notice the strip has irregular decelerations with sharp tracings down and back up that generally do not have a pattern with contractions. What is this called?
Variable decelerations
List two reasons for decreased CVP
Vasodilation (less fluid getting back to heart) Hypovolemia (reduced preload)
The inability of getting oxygen molecules down through airways, through alveolar membrane, and onto a red blood cell, ultimately attaching to a hemoglobin molecule.
Venous admixture or V/Q mismatch (Q stands for cardiac output/flow)
List 3 s/s of cushing syndrome
weight gain, buffalo hump (fat pad at base of neck), hirsutism, skin changes (stretch marks, easy bruising), menstrual irregularities, impotence, osteopenia
What is the J point?
where the S wave meets the isoelectric line, the beginning of the ST segment
On a head CT, fresh blood (typically <36 hours old) appears ___ in color, and older blood appears ___.
white, black (can see a mix - for example head bleed that stopped and started rebleeding)
What are the 3 signs of cushings triad and what can it indicate?
widened pulse pressure, bradycardia, cheyne-stokes respirations (erratic/irregular pattern) *can indicate herniation *standard increased ICP patient without herniation typically tachycardic (cardiac centers not being compressed in brain yet)
According to Charles's law, if pressure is constant, what is the relationship of volume and temperature?
directly proportional (temp up = volume up, temp down = volume down) (*think car tires*)
ScVO2 is drawn off of what?
distal port of central line (central venous oxygen saturation - 5-8% higher than an SvO2)
List 3 management considerations in beta blocker toxicity
fluid resuscitation (20ml/kg), glucagon (5mg - increases myocardial contraction), inotropes/chronotropes (think higher doses, milrinone 300 mcg/kg can work well in these patients), high dose insulin (1-10 U/kg/hr), cardiac pacing
What is the scoring for motor response on the glasgow coma scale?
follows commands=6 localizes pain=5 withdraws=4 flexion=3 extension=2 none=1
Ingestion of what two plants can mimic digitalis toxicity?
foxglove and yellow oleander (cardiac glycoside toxicity)
How is Hgb measured?
g/dL
What trick can be used to estimate ETT size on neonates?
gestational weeks - move decimal over one ex: 25 weeker - 2.5 ETT, 30 weeker - 3.0 ETT, etc. (can also double ETT size for NG/OG/suction french size)
What will the skin of somebody with heat stroke look like?
hot and dry (can no longer sweat)
For CAMTS certification, flight crews either need to have various aspects of clinical training, OR ______ ______ ____ training in the four age categories of _____, _____, ____, and ____ at least one time per year in a testing setting.
human patient simulation, neonate, pediatric, adult, high risk OB
List 2 reasons for low RBCs.
iron deficiency, blood loss, bone marrow suppression (formed within bone marrow), hemolysis
A head injury that occurs by coup/contracoup force and causes nerve fibers to be shorn/torn/stretched as a result of the impact
Diffuse Axonal Injury -also often (maybe always?) results in small petechial hemorrhages as well
How does digitalis work?
Digitalis medicines strengthen the force of the heartbeat by increasing the amount of calcium in the heart's cells. (Calcium stimulates the heartbeat.) When the medicine reaches the heart muscle, it binds to sodium and potassium receptors. These receptors control the amount of calcium in the heart muscle by stopping the calcium from leaving the cells. As calcium builds up in the cells, it causes a stronger heartbeat. Digitalis medicines control irregular heart rhythms (called arrhythmias) by slowing the signals that start in the sinoatrial (SA) node. This, in turn, reduces the number of signals that travel through the atrioventricular (AV node). Fewer signals mean fewer arrhythmias.
A 12 lead reveals a shortened QT interval and a downsloping "scooped" ST segment. What medication do you think the patient may be taking?
Digoxin (ST segment change referred to as salvador dali sign - scoops like his mustache)
SvO2 is drawn off of what?
Distal port of a swan ganz (PA catheter) - blood in pulmonary artery just before it enters the lungs
A positive deflection at the J point best seen in lateral leads, v3-v5
Osborne (J) wave (can be seen in hypothermia (as hypothermia worsens it gets bigger), hypercalcemia, certain neuro insults, brugada sometimes, normal variant in some individuals)
Your square wave test on your art line reveals no oscillations after the square wave, delay in returning to baseline waveform, what does this mean and what may be causing it?
Over damping - often caused by small air bubble or blockage, (too stiff, system is not sensitive enough)
How do you calculate a partial pressure of oxygen?
Oxygen in mmHg x oxygen concentration Ex: 760mmHg (sea level) x 0.21 (normal O2 % in air) = 159.6mmHg (partial pressure aka available amount of oxygen in atmosphere)
What do the values of P1V1=P2V2 for Boyles law mean?
P1 = starting ATM at the lowest altitude V1 = starting volume (ETT cuff, epigastrum, etc.) P2 = highest ATM based on highest altitude V2 = ending volume as impacted by highest altitude *constant temperature*
What is the preferred view for a chest xray?
PA (posterior to anterior, xray plate anterior)
What pressure can you use to estimate the wedge pressure?
PA diastolic pressure - wedge pressure will be 3-4mmHg higher
One potential way to optimize gas exchange is to increase surface area of alveoli by adding ____.
PEEP
Pressure applied to the airway at the end of expiration to maintain alveolar recruitment
PEEP
Drugs that bind with receptors and block the intrinsic action of the receptors
antagonist ex: vec, metoprolol
The most common type of spinal cord syndrome resulting in complete motor, pain, and temperature loss below the level of injury
anterior cord syndrome
The right and left coronary arteries come off of the base of the ____ right above the ____ valve
aorta, aortic
When the _____ valve closes is when diastole happens and when ____ perfusion is optimized.
aortic, coronary
The IABP inflates immediately after ____ valve closure, represented by the ___ notch on waveform.
aortic, dicrotic
Barodentalgia (think boyles law) occurs in which phase of flight?
ascent
What is the antidote for organophosphates?
atropine, 2-pam
For every 10mmHg change in PaCO2, the pH will change by ___ in the opposite direction.
.08
Bedside calculation to estimate PaO2?
(700 torr x FiO2) - 50 ex: (700 x .5) - 50. (*700 = estimated atmospheric pressure, .5 for FiO2 of 50%)
Desired FiO2 based on altitude formula?
(FiO2 x P1) / P2 *P1 is current barometric pressure *P2 is barometric pressure at highest flight altitude (to maintain same level of oxygen therapy at a higher altitude)
*Look at rule of 9s for adult and peds diagrams*
*
hypemic hypoxia
-Reduction in oxygen carrying capacity of the blood. -Anemia, blood loss, cigarettes and carbon monoxide (ABCC) can cause Hypemic Hypoxia.
What is one way to try to manage a nuchal cord baby?
1) If cord is loose enough draw it down over the head *best option* (before delivery) 2) as baby comes out perform somersault maneuver where babies head goes up towards mothers pelvis to prevent extra cord tension 3)*last resort* cut and clamp cord, ideally after shoulders are delivered if needing to be done (can affect fetal transition)
What are the 5 things to look at when trying to determine where you are getting negative base excess - before albumin correction? (ex: base excess -18, looking for 16 extra acid molecules)
1) Na level 2) Cl level (ex: if normal Cl 102, but Cl is 110 - there is 8 of the extra acids) 3)Lactate (ex: lactate 6, normal is 0-2, there is 4 of the extra acids) 4)Ketones (+ or -, no great way to quantify how many acids) 5)Toxic Alcohols (worst reason to have base excess)
3 P's of ETCO2 that could explain low ETCO2 besides hyperventilation
1) Pulse (do they have one?) 2) Perfusion (what is their MAP?) 3) pH (severe acidosis causing partially compensated metabolic acidosis)
How is fluid given for burn resuscitation using the consensus formula?
1) calculate total volume for 24 hours 2) give half of calculated volume over first 8 hours 3) give 1/4 of total calculated volume over second 8 hours, re-evaluate 4) if needed give last 1/4 of total calculated volume over last 8 hours
What are the bodies three main buffering systems?
1) carbonic acid-bicarbonate buffering system 2) respiratory buffering system 3) kidneys
What are the 3 Sgarbossa criteria?
1) concordant STE >1mm (in any lead with primary R wave) = 5 points 2) STD >1mm in V1-V3 (any of these, don't need all 3) = 3 points 3)discordant STE >5mm = 2 points *need 3 points for probability of associated MI, more points = more probability*
How can you identify SVT with aberrancy on a 12 lead?
1) correct rate for SVT 2) aVR showing primary QS wave 3) V6 showing primary R wave
How do you help identify a left anterior fascicular (hemi) block?
1) qR complex in lead 1 & aVL 2) rS complex in lead 3 and aVF 3) look for ST elevation (not needed?)
How do you identify a posterior fascicular block?
1) rS complex in lead 1 2) qR complex in lead 2 and 3 3) look for ST elevation (not needed)
What ECG leads are affected by L Circumflex occlusion?
1, aVL (both high lateral) V5, V6 (both lateral, could also be left marginal or left diagonal branches)
4 types of hypoxia
1. Hypoxic 2. Histotoxic 3. Hypemic 4. Stagnant
Normal range of urine specific gravity
1.005-1.030
Each gram of Hgb carries how much O2?
1.34 mL
What is a normal magnesium level?
1.5-2.5
Dopamine doses >___mcg/kg/min can cause a significant drop in cardiac output due to vasoconstriction and tachycardia from chronotropic effects
10
Troponin peaks at ___ hours and can stay in the system for approximately ___ weeks.
24, 2
Serum Bicarbonate normal on a BMP/CMP?
26-30 (measuring total CO2 as bicarb is bound to the CO2)
What is barometric pressure at sea level?
29.92Hg
Where on CXR should you see the radio-opaque marker of the tip of the IABP to confirm correct position?
2nd intercostal space L side
Stage of labor that begins with complete effacement and dilation and ends with delivery of baby.
2nd stage
In a pregnant woman, BP tends to decrease in ___ trimester but is back to baseline by ___ trimester.
2nd, 3rd
1 amp of calcium chloride equals about how many amps of calcium gluconate?
3
How many different restraint belts at minimum need to be on the aircraft patient stretcher?
3
In a normal state, Hct should be ___ x that of Hgb.
3
Resuscitation in a hypothermic patient typically occurs until patient is at least within what temperature range?
30-32 C
At approximately ___-___ weeks of pregnancy and after you should have good fetal heart rate variability.
30-32 weeks (before that may be too mature to have the nervous and cardiac systems developed enough to give good variability)
What is a normal phosphorous level?
3.0-4.5
Normal Potassium?
3.5-5.0 mEq/L
On a normal oxyhemoglobin dissociation curve, you can subtract ___ from your SpO2 and it will give you a reflective rough PaO2.
30
The goal for a plateau pressure is to be <___
30
At what time point of no contact with dispatch (verbal or satellite) from an aircraft that was in flight will a search be initiated?
30 minutes (15min PAIP will start to activate and get process going but not search until 30 minutes)
To correct base excess for albumin (identify acid factor): 1) [(normal albumin __.__ - patient albumin)]2.5 2) _____ - answer from #1 = corrected BE
4.5, base excess (*math tip - a negative minus a negative = a positive - ex: -10 - (-2.5) = is same as -10 + 2.5)
List 2 management considerations for snake bite
ABCs, immobilize as much as possible, know how much time elapsed since snake bite, bring somewhere for Antivenin (if moderate/severe especially), monitor for systemic reaction, mark/outline area and time it (no longer doing tourniquets)
In diabetes insipidus there are low or no levels of ____ causing the kidneys to not retain any fluids.
ADH
In an ___ Chest Xray view the heart may seem larger than it is due to the particular view.
AP (projecting from front to back so tends to appear to enlarge heart)
What part of the heart is responsible for slowing down conduction enough to allow time for ventricles to fill?
AV node
A negative base excess/base deficit (>-2) indicates extra ___.
Acid
CO2 + H2O ↔ H2CO3 ↔ H+ + HCO3-
Acid-Base Formula
A strong ion difference of <38 indicates ____, and >38 indicates ____.
Acidosis, alkalosis
In an ABG, if HCO3 is <22 it is considered ____.
Acidotic *think not enough base = acidic
ATP is a product of what type of metabolism?
Aerobic
If rhabdo is untreated, what does it lead to?
Acute Tubular Necrosis
List 3 options to consider for fetal distress management
Administer oxygen, rule out cord prolapse, left lateral positioning, IV fluid bolus, stop uterotonic agents such as oxytocin, and modifying pushing efforts (pushing every other or every 3rd contraction instead of every contraction)
What are two contraindications to etomidate?
Adrenal insuffiency (inhibits cortisol production) and Sepsis
____ is a weak acid that can cause false elevation or false low of base excess.
Albumin
In an ABG, if CO2 is <35 it is considered ____.
Alkalotic *think not enough acid = basic/alkalotic
What is Newton's first law?
An object at rest stays at rest and an object in motion stays in motion unless acted upon by an outside force.
Measurement between cations and anions
Anion Gap
V1, V2, V3, V4 have 2 or more ECG lead changes - what type of MI?
Anterior wall (V1/V2 used to be separated as septal and V3/V4 anterior - getting away from that terminology now and most places all V1-V4 should be considered contiguous leads)
What type of medications can help prevent bronchoconstriction from re-occuring, as well as potentiating bronchodilating effects from bronchodilators?
Anti-cholinergics (ie: ipratropium) (can also use inhaled atropine/NS mix if no other option, has a max)
How is serum osmolality regulated?
Anti-diuretic hormone
What is the Mauriceau maneuver?
Applying gental suprapubic pressure with one hand and one pressing baby chin gently into chest to try to facilitate delivery of breech presentation fetal head
A patient with a spinal cord injury at or above T6 has something causing them discomfort and their blood pressure starts increasing significantly, what is this called and what is the most common cause?
Autonomic Dysreflexia *most common cause is full bladder as patients cant feel bladder is full - make sure foley isn't kinked if in place
______ is secreted by cardiomyocytes based on ventricular stretch, lab often used in CHF patients.
BNP (general normal <100) Age differentiated: (0-74yo BNP <125 normal, 75-99+yo BNP >450 indication of signifcant stretch)
The ___ lab is a good indicator of overall renal health.
BUN *shows how well we are getting rid of urea (waste product of liver)
Type of WBC that often elevates in inflammatory response state.
Basophil
This lab measures the % of blood volume that is made up of RBCs, it is also the predominant ketone body at the onset of DKA.
Beta Hydroxybutyrate (0.4-0.5 mmol/L) (Ketones could also be being produced for other reasons than DKA - match to patient presentation)
What effect is being described: hemoglobins oxygen binding affinity is inversely related both to acidity and to the concentration of carbon dioxide
Bohr effect (explains right shift on oxyhemoglobin disassociation curve) (in an acidotic state, hemoglobin isn't very attracted to oxygen, and things like hydrogen and CO will take binding spots on hgb instead of all oxygen - normally 4 "seats at the table" typically filled with oxygen)
In the carbonic buffer system, the first step is the body combines ___ + ___ from the muscles/tissues to create carbonic acid (H2CO3).
CO2 + H2O
A cardiac syndrome characterized by normal QT interval, pain free, only detected on ECG, biphasic T waves V1-V2, s/s: dizziness/syncope/labored breathing/palpitations, young sudden cardiac arrest - sodium channel anomaly.
Brugada Syndrome (more common in young males, asian descent)
A patient with an obstructive lung process ( ____ or asthma) should be ventilated focusing on allowing for enough ____ time. Strategies include starting the respiratory rate at ___-___, and an I:E ratio of __:__. These patients should also usually be placed on ___ml/kg IBW for Vt to maintain appropriate minute volume with a lower rate.
COPD, exhalation, 10-12, 1:4, 8 (rate of 10-12 should put rate at 1:4 automatically)
What is the formula for calculating cerebral perfusion pressure?
CPP = MAP-ICP
[(1.34mL x Hgb x SaO2)] + (PaO2 x 0.003) is the formula for what?
CaO2 (the amount of oxygen that we deliver that ultimately attaches to the hemoglobin) - arterial oxygen content
Because there is no damage to the pulmonary/capillary bed in the chronic bronchitis type of COPD, the body thinks it is a ___ ___ problem.
Cardiac Output (decreases ventilations, increases cardiac output - therefore leading to CO2 retention, leading to pulmonary vasculature constriction over time, and then signs of R sided heart failure)
2, 3, avF accompanied by V5, V6 changes on an ECG is associated with what type of occlusion?
Circumflex (10% of population is left dominant and their circumflex wraps around to feed inferior wall instead of RCA)
The most common cause of variable deceleration is ___ ___.
Cord compression *can also be related to premature rupture of membranes or decreased amniotic fluid - which typically are leading to a cord compression state, increase chance of cord prolapse*
[Na+ - (Cl+HCO3-)] + K is the formula for what?
Corrected anion gap **tip: HCO3- in this case is the serum bicarb which is reflected as the CO2 readout on a comprehensive metabolic panel (CO2 and HCO3 bound together)**
What is the lab that helps indicate muscle breakdown and kidneys ability to filter it out?
Creatinine
Name 2 things that could decrease platelets
DIC, sepsis, HIT, bone marrow failure/suppression, certain medications, certain viruses(biggest - EBV, chickenpox, AIDS), (and more)
hypoxic hypoxia
Deficiency in alveolar O2 exchange
If you have a base excess of -16, you could also call this a base ____ of 16.
Deficit
Elevated hct levels are commonly caused by ____.
Dehydration (lower plasma levels with dehydration = increased % of RBCs being measured)
T/F: CAMTS accreditation is required.
False
T/F: There is a universal anitvenin for scorpion envenomation
False (US concerned about bark scorpions - there is antivenin for this - anascorp)
T/F: Subarachoids do not commonly rebleed
False *high risk of rebleeding due to small vasculature coming off circle of willis under high pressure
T/F: Brown recluse spider bites have immediate symptoms
False *significant pain (vasospasm) and itching 6-8 hours later, then edema around bite and red ring, then 24-72 hours later vesicle develops
T/F: HHNK patients do not produce insulin
False - DO produce insulin (unlike DKA patients)
T/F: Subdural bleeds are always acute.
False - acute, subacute, or chronic (acute 40-60% mortality rate)
T/F: Beta blockers work mostly on beta 2
False - beta 1 (can have minimal beta 2)
T/F: Patients with kidney disease always have an increase in Ca++ levels.
False - decrease
T/F: As altitude increases, the measurement of Atmospheres (ATMs) also increases.
False - decreases
T/F: The intracellular fluid compartment holds less fluid than the extracellular fluid compartment.
False - intracellular is dominant at appx 2/3, extracellular 1/3
T/F: During uterine inversion remove the placenta to help with bleeding.
False - leave placenta attached or it could make bleeding worse
T/F: The respiratory buffering system takes hours to days to produce results.
False - minute to minute
T/F: DIC is an understimulation of the clotting cascade and is often a primary idiopathic event.
False - overstimulation of clotting cascade, always occurs as a secondary event to something else
T/F: If a pregnant woman is having regular contractions 5-6 minutes apart prepare for imminent delivery.
False - typically 1-2 minutes apart
T/F: Carbonic acid likes to stay bound together as H2CO3.
False - volatile compound, likes to break apart
T/F: Vtach can be >200ms (0.2 sec)
False - vtach will never be that wide - what else may it be?
Quick way to estimate patients PaO2 using FiO2?
FiO2 x 5
What are the 3 H's to remember for prevention of secondary brain injury?
Hypoxia, hypotension, hyperventilation
The highest pressure on the timing waveform for an IABP should be what?
IABP Augmented Peak Diastolic Pressure *after dicrotic notch *inflation of balloon, causing high pressure in central aorta, therefore increasing coronary artery perfusion pressure and myocardial oxygenation
List 2 medications to consider in pregnancy induced hypertension and preeclampsia.
IV betablocker (often hydralazine or labetalol), oral immediate release nifedipine *mag if very high risk for seizures or if they start seizing, then can add valium/ativan as well if seizing*
List 2 considerations of myxedema coma management
IV thyroid hormone replacement, IVF replacement, vasopressors as needed, glucocorticoid administration, correct hypothermia if present
When would you clamp a chest tube?
If on initial insertion you have >1500ml of volume loss, or 250cc/hr for 3+ hours (concern for reinflation pulmonary edema)
When would you calculate a corrected sodium?
In a severely hyperglycemic patient *Measured Na+ [.016 x (serum glucose - 100)]
What is Larson's Maneuver
In cases of bronchospasm (for ex: related to pushing ketamine too quickly) - place pressure behind the earlobe bilaterally and behind the jaw raising the jaw and helping relax the vocal cords
2, 3, and aVF have 2 or more ECG lead changes - what type of MI?
Inferior wall
What is the consensus formula for initial resuscitation of a burn patient?
Kg x TBSA x 2-4mL = volume/24 hours Adult=2mL/kg Peds=3mL/kg Electrical burns=4mL/kg
What is the Parkland Formula for initial resuscitation of a burn patient?
Kg x TBSA x4mL = volume/24 hours
Potassium is regulated by the ____.
Kidneys
What is the fluid of choice in burn patients?
LR
List 3 reasons for an increased pulmonary capillary wedge pressure
LV Failure (fluid backing up) Mitral Valve Disease Cardia Tamponade (CO reduced, not clearing ventricle) Fluid Overload
What is a main cause of vasodilation in septic patients?
Large amounts of neutrophils in response to the infection, neutrophils release nitric oxide which is a potent vasodilator
When monitoring the fetal heart rate you notice smooth shallow dips in heart rate that begin at or after the peak of contraction and dont return to baseline until after the contraction has ended. What is this called?
Late deceleration - most worrisome! *Think fetal hypoxia, uterine/placental insufficiency*
What is the worst kind of timing error for IABP therapy?
Late deflation (heart trying to go into systole and contract against the barrier of the balloon, increases myocardial oxygen demand significantly)
You notice that you have a Vt set for 500mL and are consistently getting back 300mL for Vte. What is the most common cause and first thing you want to check for?
Leak - leak in the circuit, leak in balloon, back up airway causing leak
The PA diastolic pressure indirectly reflects what other pressure?
Left Ventricular End Diastolic Pressure
Low temp, low acid, low 2,3-DPG cause what type of shift?
Left shift *Low temp - hypothermia, sepsis, myxedema coma *Low acid - respiratory or metabolic alkalosis *Low 2,3-DPG - primary problem with PRBC administration (citrate encapsulates 2,3-DPG) - problem with MTP typically (over 6 units) - give calcium to help with this. whole blood lowers this problem *causes low PaO2 as hemoglobin has high affinity to O2 and won't offload stores
List 3 causes of acidosis
Metabolic - DKA, sepsis, shock, severe diarrhea, renal failure, salicylate overdose Respiratory - Airway obstruction, COPD, chest trauma, drug OD, pulmonary edema (hypoventilation)
What is the antidote for methemoglobinemia?
Methylene blue
What is the antidote to potassium cyanide poisoning?
Methylene blue
This cation is found appx 50% in bones and 45% in intracellular fluid.
Mg++
A subfalcine herniation is commonly written on CT scans as what?
Midline Shift
Hypothermia with temps ranging from 32-35 celsius is typically defined as what stage?
Mild
An ABG with with a high CO2 and a low HCO3 would be considered a ____ disturbance.
Mixed disturbance (verses a compensation) (high CO2 = acidotic, low HCO2 = acidotic - not opposites, not a normal response, not compensating)
Hypothermia with temps ranging from 28-32 celsius is typically defined as what stage?
Moderate
What stage of hypothermia does the patient lose the ability to shiver?
Moderate (28-32 celsius)
What medication needs to be given for acetaminophen overdose?
N-Acetylcysteine (mucomyst) *Binds to acetaminophen metabolite and renders it ineffective
How do you calculate a strong ion difference?
Na - Cl
Chloride passively follows ____ and water.
Na+
What is the dominant extracellular cation?
Na+ (90%)
List 3 of the bodies most common cations.
Na+, K+, Ca++, Mg++, H+
What is Beck's triad?
Narrowing pulse pressures, Muffled Heart Sounds, JVD **Characteristic for Cardiac Tamponade**
An anion has gained valanced electron(s), and therefore has a ____ charge.
Negative
What is the largest most predominant type of WBC?
Neutrophils *usually first ones to arrive, job is to ingest and get rid of bacteria
What does the acronym Never Let Monkeys Eat Bananas stand for in regards to types of WBCs?
Neutrophils, Lymphocytes, Monocytes, Eosinophils, Basophils
What B vitamins strongly facilitate the krebs cycle?
Niacin and Riboflavin
When is TXA given in DIC patients?
Only if they are actively bleeding
What portion of the ECG is when the right ventricle is being passively filled?
PR interval
An ABG with a low CO2 and a low HCO3 would be considered ____ compensated.
Partially (opposites - low CO2 = alkalotic, low bicarb = acidotic)
Measurement given after every breath of the upper airway flow/resistance, will be the highest pressure.
Peak Inspiratory Pressure
A cation has lost valance electron(s), and therefore has a ____ charge.
Positive
A deficiency in chloride will lead to a deficiency in ___ and vice versa.
Potassium
What is the dominant intracellular cation?
Potassium
Preeclampsia will present with very similar symptoms to pregnancy induced hypertension (PIH) but has one key difference - what is it?
Preeclamptic mothers WILL have proteinuria, PIH mothers will not
A fetal delivery complication where the cord is the presenting part and has a high risk of fetal demise
Prolapsed cord
How is shock index calculated?
Pulse rate/Systolic BP
A decrease in systolic blood pressure >10mmHg during inspiration
Pulsus Paradoxus (can see in asthma, pericardial tamponade, obstructive pulmonary diseases, and more) (In case of asthma/obstructive pulmonary it is due to hyperinflation and/or increased intrathoracic pressure, decreased amount of blood return to L heart)
List 2 things to consider if prolapsed cord delivery
Put mom in knee to chest or steep trendelenburg, do not have mom push, high flow O2, putting hand in vaginal canal to try to put pressure onto fetus to lift away from cord, c-section!
On a hamilton t1, to help caluclate what your expiratory time should be, find the _____ number and multiple it by ____.
RcExp, 3 (hamilton has already done some calculations for you)
A patient presents in wide complex tachycardia at a rate of 150, and QRS duration >200ms, what is this?
Really, really, wide complex tachycardia! - cause - hyperkalemia *No sodium or calcium channel blockers (amio, lido, procainamide, etc.* - treat with calcium gluconate/chloride, bicarb - QRS should become narrower
List 2 common causes of elevated BUN
Renal failure, CHF, high protein diets, hypovolemia
List 3 considerations for management of placenta previa
Replace volume loss, prepare for C-section, High flow O2, defer vaginal exams, assess contractions/fetal heart rate/fetal movement, tocolytics
Where do you place the SPO2 probe on a neonate/newborn to get a pre-ductal SPO2 reading?
Right hand/right wrist
Raised temp, raised acid, raised 2,3 - DPG will cause what type of oxyhemoglobin shift?
Right shift *raised temp - thyroid storm, fever, drug ingestion, excited delerium, etc. *raised acid - respiratory or metabolic acidosis *raised 2,3 DPG - more chronic, COPD patients (usually polycythemic - overproduction of RBCs), also seen in athletes using blood doping/taking epogen *end result Raised PaO2
List 3 potential reasons for increased CVP
Right ventricular failure/infarct (back up of fluid into RA) Tricuspid insufficiency (regurg into right atrium) COPD (heightened PA pressures limiting blood flow into PA, back up into RV, back up into RA) Left Sided Heart Failure (volume eventually backs up into RA) Pulmonary HTN Tension pneumo Cardiac Tamponade PEEP
What is the typical blood pressure goal for subarachnoid hemorrhage patients?
SBP <140
What is the formula for pulse pressure?
SBP-DBP
What is the SBP scoring for revised trauma score?
SBP: >89 = 4 76-89 = 3 50-75 = 2 1-49 = 1 0 = 0
What criteria would make you concerned for left main insufficiency/3 vessel disease process based on latest research?
ST elevation in aVR ST elevation in V1 ST elevation in aVR > V1 anterior ST depression
Amount of solute in the serum part of the blood
Serum Osmolality (275-295) - think "cellular hydration"
You compare your bedside calculation estimate of PaO2 to an actual ABG and notice a large disparity, what physiological process is likely occuring?
Shunt physiology (alveoli are perfused with blood as normal, but ventilation/oxygenation fails to supply the perfused region)
When the alveoli are perfused with blood as normal, but ventilation/oxygenation fails to supply the perfused region
Shunting (may often be caused by some sort of blockage - PE, infectious process/fluid)
You are monitoring a fetal heart rate strip and notice a sine wave/(atrial flutter looking) type appearance of a heart rate that stays between appx 120-160 but has no variability out of that range and it does not change with contractions. What is this called?
Sinusoidal (rare) Ominous finding, requires immediate C-section, usually indicates fetal anemia or hypoxia
____ is the cation responsible for determining osmotic pressure.
Sodium *this causes extra-cellular/intra-cellular fluid shifting*
Refers to the fetal head in relation to the mothers pubic bone/ischial spines
Station (measured -3 (further up in birth canal) to +3 (further down in birth canal) *think +4 on the floor*
How do you calculate what ventilator rate to use based on target minute ventilation?
Step 1: Calculate target minute ventilation (100 ml/kg/min x pt weight) ex: 100 x 80 = 8000ml Step 2: Calculate Vt (pt weight x ml/kg wanting to use on vent - 6-8) ex: 80 x 6 = 480ml Step 3: Target VE/Vt = breaths per min ex: 8000ml/480ml = 16.6 breaths per min
Flicker Vertigo is primarily caused by what?
Sunlight passing through the rotors (lower spinning 5-20Hz - can cause vertigo and seizure activity)
How is HELLP syndrome treated?
Typically needs immediate delivery of baby
A classic sign of hypokalemia on an EKG is ___ waves.
U (appears as QT segment prolongation) *also could have T wave flattening, T wave inversion, arrhythmias, ST segment depression
A pregnant mother presents with decreased fundal height compared to gestational age, decreased fetal heart rate, loss of round shape of pregnant abdomen, and has had a previous C-section. What are you concerned for?
Uterine rupture (increased risk if previous c-section but not necessary to have had prior - symptoms will depend on degree of rupture and gestational age of fetus)
What lead should you look at first in a 12 lead and why?
V1 - can use to see if you have a BBB if QRS >0.12 as it may change how you read rest of ECG
To help in identifying axis deviation, what are the first few leads you should look at?
V1 - make sure QRS not > 0.12 Lead 1 - what is the primary impulse? (ex: R) - what direction does it point? Lead 3 - what is the primary impulse? (ex: S) - what direction does it point? *if lead 1 and lead 3 point away - left axis, point together - right axis*
What ECG leads are affected by the left main or LAD?
V1, V2, V3, V4
What leads only need 1/2mm of ST elevation to determine a STEMI?
V4R or V7, V8, V9 (rest of leads need 1-2mm based on protocol in 2 or more contiguous leads)
What is the most ominous type of pelvic trauma?
Vertical sheer (can hemorrhage out blood volume into pelvis)
When are lymphocytes most commonly elevated?
Viruses
What does VMC stand for?
Visual Meteorological Conditions
List 3 reasons for an increase in pulmonary artery pressure
Volume Overload Atrial and Ventricular Defects Pulmonary problems (COPD, asthma, emphysema, etc.) Mitral valve regurg/stenosis (blood volume back up LV -> LA -> PA) LV Failure (volume back up if not mobilizing fluid out)
How can you tell Vtach on a 12 lead (vs SVT with aberrancy)?
Vtach - aVR will have primary R wave, V6 will have primary QS wave
To help identify/look for various EKG anomalies, what does the acronym WaLDO SHIP mean?
W - wellens syndrome a - aVR L - left bundle branch block D - De Winters T waves O - out of hospital ROSC S - subtle inferior or lateral H - hyperacute T waves IP - isolated posterior MI
A cardiac finding that notes wither biphasic T waves in V2-V3 or deep symmetric inverted T waves in any precordial leads, no significant ST elevation, patient is pain free, indicative of severe proximal LAD stenosis.
Wellens' syndrome
Trosseau's sign
When BP cuff on arm is inflated wrist contracts up (hypocalcemia)
What are night FAA minimums for local mountainous areas with and without NVGs?
With NVGs: 1000' - 3 miles Without NVGs: 1500' - 3 miles
What are night FAA minimums for local non-mountainous areas with and without NVGs?
With NVGs: 800' - 3 miles Without NVGs: 1000' - 3 miles
Why are heparin and anti-thrombin III a big component of treatment in DIC patients?
With the overproduction of clotting factors, clots form and float throughout the body, often blocking vessels and causing tissue necrosis. Giving heparin helps to prevent the conversion of clotting factors to active form to try to decrease/prevent formation of clots within the body.
What does ADP stand for?
adenosine diphosphate
What does ATP stand for?
adenosine triphosphate
What is 2,3 DPG?
a molecule thats attached to every red blood cell and whose job is to offload oxygen from the hemoglobin when needed
What medication is often used to try to treat metabolic alkalosis?
acetazolamide (diamox) - good at optimizing bicarb elimination **also check and correct electrolytes**
Sodium is a strong ___ and helps maintain acid-base balance.
acid
To calculate mechanical deadspace for an adult take ___ x ___, and for a pediatric take ___ x ___.
adult: 2 x PIP pediatric: 1 x PIP
List 3 considerations for management of Diabetes Insipidus
agressive IVF replacement, vasopressin (acts as synthetic ADH), Desmopressin/DDAVP (less vasopressor effects), monitor urine specific gravity, monitor for cardiac changes, monitor for electrolyte imbalances
List 3 signs of hypokalemia.
altered mental status, bradycardia, hypotension, tachycardia, PACs, PVCs, cardiac arrest, ventricular arrhythmias, hypoventilation, decreased muscle strength, tetany, decreased deep tendon reflexes, fasciculations
The amount of gas that contributes to gas exchange
alveolar minute ventilation
What is the antidote for cyanide?
amyl nitrate, Na thiosulfate
Patients in thyroid storm quickly go into an ____ metabolism state, causing ____ accumulation within the body as well
anaerobic, lactate
The amount of gas delivered that does not contribute to gas exchange
anatomical dead space (the volume delivered by the vent that is trapped in the chest and doesn't reach the alveoli)
List 3 reasons for suboptimal diagnostic augmentation of an IABP
balloon in sheath, balloon not unfolding, poor positioning, catheter kink, helium leak, timing, tachycardia (may need to switch to 1:2 timing), augmentation control
Due to Boyle's law, what type of physiologic process/pain may you experience on descent?
barotitus media - can't equalize ears (for test: only clinical issue that occurs on descent, sinusitis ascent)
What does the ST segment represent on an ECG?
beginning of ventricular repolarization
Bronchodilators work on what receptors?
beta 2 smooth muscle relaxer - open airways
Where is the mitral valve located?
between left atrium and left ventricle
Where is the pulmonic valve located?
bewtween the right ventricle and pulmonary artery
List 3 considerations for management of thyroid storm
block formation of new hormones in the thyroid gland, inhibit action of hormones already formed, identify and treat precipitating event, no aspirin (increase amounts of circulating hormone within body), administer glucocorticoid (prevent conversion of T3 to T4, prevents adrenal sufficiency from cortisol depletion), administer beta adrenergic blocking agent (help decrease tachycardia and tremor), give Propylthiouracil and/or methimazole (antithyroid agent)
Aspiring crosses the ___ ____ ___, triggering the respiratory center of the brain to cause _____ventilation and therefore a respiratory alkalosis.
blood brain barrier, hyperventilation
If the foramen ovale does not fully close after birth, what will happen?
blood will continue to mix between right and left atrium
List 2 signs/symptoms of placental abruption
board like abdomen, tenderness to palpation over uterus, dark red bleeding (*can be significant risk to fetus due to placenta being how it gets O2/nutrients*)
Phosphodiesterase inhibitors helps to improve ____dilation, improve contractility of the ____, and increase stimulation within the ____ center of the brain.
bronco, diaphragm, respiratory (ex: Theophylline, daliresp, sildenafil)
A spinal cord injury that is a hemisection of the cord (usually cervical), very rare
brown sequard syndrome
A spinal cord injury that results in reduced loss of motor function with preserved pain and temperature sensation on side of the lesion, and pain and temperature loss on the opposite side with preserved motor function
brown sequard syndrome
What elctrolytes does the fluoride from hydrofluoric acid combine with when seeped into the tissues?
calcium and magnesium -check these labs, renders calcium and magnesium ineffective
List 3 management considerations for calcium channel blocker toxicity
calcium loading (gluconate or chloride), glucagon, insulin, atropine, pacing, pressors
In malignant hyperthermia, ____ is released causing sustained muscle contraction and the ____ nervous system is activated.
calcium, sympathetic (causes an extreme oxygen demand)
How do you calculate target minute ventilation (accounts for anatomical dead space)
calculate 100ml/kg/min for patient weight (ex: 80 kg patient = 100x80 = 8000ml)
If CK-MB to CK ratio relative index is >2.5-3.0 there is likely ___ muscle damage, if high CK and relative index is <2.5-3.0 there is likely ___ muscle damage.
cardiac, skeletal
A spinal cord injury resulting in greater motor weakness in the upper extremities than lower, varying degree of sensory loss
central cord syndrome
List 4 potential causes of SIADH
certain types of lung carcinomas, head trauma, brain tumor, meningitis, CVA, encephalitis, hypoxemia, high stress states, medications including: anesthetics, narcotics, TCA, acetaminophen, and anticonvulsants
List 3 causes of right axis deviation
chronic COPD, RVH, PE, tricyclic OD, lateral wall MI, left posterior hemiblock
In the ____ ____ type of COPD, there is no damage to the pulmonary/capillary bed, whereas with the ____ type the pulmonary/capillary bed is damaged.
chronic bronchitis (problem is excessive tracheo-bronchial secretions and inflammation in the lungs), emphysema
Congenital heart defect with narrowing of the aorta typically just distal of the left subclavian bifurcation
coarctation of the aorta (many cases where these newborns go home undiagnosed and have sudden cardiorespiratory decompensation when PDA closes as it was acting as a secondary outflow tract)
List 3 signs of hypercalcemia
confusion, hypotonia/hyporeflexia, paresis, volume depletion, signs of pancreatitis, arrhythmias, shortened QT interval, hypotension
Hypocapnia can cause vaso____ and hypercapnia can cause vaso_____.
constriction, dilation
What is the modified verbal response GCS scoring for pediatrics?
coos, babbles=5 irritable=4 cries to pain=3 moans to pain=2 none=1
2 main goals of IABP therapy are to increase ____ ____ perfusion and to decrease ___.
coronary artery, afterload
In a ____ heart defect the patient will not oxygenate with a closed PDA.
cyanotic
What causes the bradycardia in hypothermia?
decrease of depolarization of pacemaker cells within the heart (because of this wont usually be responsive to initial epi, atropine, etc. since its not vagally mediated)
Patients with myxedema coma will have ___ levels of free T3 and T4, and _____ levels of TSH
decreased, increased
According to Boyle's law, as altitude increases, barometric pressure ____, and gas in an enclosed space ____ as long as temperature remains ____.
decreases, expands, constant
The theory of counterpulsation, in which the IABP functions under, states that when the heart is in systole the balloon is ____, and when the heart is in diastole the balloon is _____.
deflated, inflated
List 3 s/s of myxedema coma
delayed reflexes, dry skin, hypothermia, altered mentation, alopecia, periorbital edema, hypotension, bradycardia
What does the P wave represent on ECG?
depolarization of the atria (in response to SA node firing)
What does the QRS complex represent in the ECG wave tracing?
depolarization of the ventricles - causes contraction phase
What part of the aorta does an IABP sit?
descending and thoracic
List 4 meds commonly used to treat hyperkalemia
dextrose, calcium, insulin, albuterol
The difference between the assisted diastole and unassisted diastole in an IABP patient is called the ____ ___ and should be __-__mmHg apart, with unassisted diastole always being higher.
diastolic dip, 5-10mmHg
Your patient reports visual aberration of yellow-green distortion. What toxicity are you most concerned for?
digitalis
A ____ radio system can transmit and receive on different channels.
duplex
When the IABP timing waveform has a characteristic "V" shape what is your concern?
early inflation (inflates before dicrotic notch causing V shape)
A patient presents with a hyperacute, symmetrical T wave appearance on an ECG - what should there be high index of suspicious of?
early sign of starting ischemia that will progress to ST elevation
Where should the dicrotic notch match up with on an ECG tracing?
end of T wave (diastolic portion)
When the _____ lining is damaged in ARDS, it allows fluid to leak out and separate the space between the ____ and the _____, causing the issues with gas exchange. It also allows fluid to leak into the ____, leading to the development of pulmonary ____.
endothelial, alveoli, capillary bed, alveoli, edema
Type of head bleed that occurs between the cranium and the dura mater
epidural
Type of intracranial hemorrhage in between cranium and dura mater
epidural
What type of head bleed would typically be associated with an impact to the pterion region of the skull?
epidural (junction of the skull bones right around area of the temple, overlies the middle meningeal artery)
A type of head bleed where the classic presentation is LOC, "lucid interval", and then neurological deterioration
epidural hematoma
Red blood cells are called ____, white blood cells are called ____, and platelets are also called _____.
erythrocytes, leukocytes, thrombocytes
How often does there have to be communication with dispatch (VFR or IFR) when in flight?
every 15 minutes (verbal or satellite)
Once on the ground, how often does there have to be communication with dispatch?
every 45 minutes
Acute exacerbation in COPD and Asthma leads to ventilatory failure by failure to ___, therefore leading to air ___ and less volume being able to be moved throughout the lungs.
exhale, trapping
The respiratory buffering system converts H and HCO3 back into CO2 and H2O, where the CO2 can now be ____ and the H2O ___.
exhaled, evaporated
Because DKA patients do not have insulin to carry the glucose into the cell for energy, they instead start breaking down free ___ ___ for energy, causing ____ production and therefore acidosis
fatty acids, ketones
List 3 potential causes of fetal tachycardia
fetal hypoxia, maternal fever, hyperthyroidism, maternal or fetal anemia, prematurity
List 2 potential causes of decreased fetal heart rate variability
fetal hypoxia, prematurity, congenital heart anomalies, fetal tachycardia
List 3 treatment considerations for digitalis toxicity
giving digibind, activated charcoal, treatment of arrhythmias (no procainamide, quinidine, bretylium - worsen conductivity within heart), no calcium (already increased cellular calcium level in these patients), use lidocaine/atropine/mag depending on arrhythmias, monitor potassium (often hyperK), temporary pacing, cardiac conversion (try to avoid if possible as cardioversion can send into asystole)
What is the antidote for beta blockers and calcium channel blockers?
glucagon, calcium (insulin?)
Glycogen is converted to _____ during glycogenesis.
glucose
Lack of ___ or O2 causes an alteration of ATP production, and the byproduct is ____ acid.
glucose, lactic
Giving insulin to a DKA patient will cause ____, ____, and ____ to shift back into the cell.
glucose, potassium, water *hydrate well so there is water to shift into the cell and avoid circulatory collapse*
A portable radio is an example of a ___ ____ radio system. It can both transmit and receive, but not simultaneously
half duplex
List 4 potential causes of DI
head trauma, high stress states, hypoxemia, infection, tumor, medication induced: dilantin, lithium, amphotericin B
List 3 signs of pregnancy induced HTN
headaches, abnormal weight gain, visual disturbances, generalized edema, oliguria, KEY ** does NOT present with proteinuria**
A hyperthermic emergency that can lead to multi-organ system failure and death due to cellular death and damage
heat stroke (>40C or 104 F)
What does HELLP syndrome stand for?
hemolysis, elevated liver enzymes, low platelets
List 2 reasons for increased RBCs
high altitude, dehydration, compensation for hypoxia (common in COPD patients)
What is the primary type of infarcts where you will see reciprocal changes?
high lateral wall (1, aVL) and inferior MIs (2, 3, avF) (will see best between aVL and lead 3 - if reciprocal changes will be mirror image of each other)
A 12 lead showing ST changes in V1-V6, 1, and aVl is concerning for an occlusion where?
high left main
Diabetes insipidus would have a ____ serum osmolality, and an SIADH patient would have a ___ serum osmolality.
high, low
The krebs cycle purpose is multifaceted: 1) Carry ___ ions into the electronic transport chain (via niacin and riboflavin bonds) 2) Forms ___ during cellular respiration (as a byproduct of niacin/riboflavin gaining hydrogen ion) 3) Form ___ more additional ATP
hydrogen, CO2, 2
When Niacin and Riboflavin, bonded with _____ ions after the krebs cycle, move into the electron tranpsport chain (or oxidative phosphorylation), the hydrogen ions pick up ____ molecules (oxidation) and become ____.
hydrogen, oxygen, H2O
Potassium loss in DKA is due to the body trying to compensate for acidosis by shifting ____ ions into the cell, and due to need for neutrality inside and outside the cell, ____ is shifted out, and then the body gets rid of the excess outside the cells in the ____
hydrogen, potassium, urine
Slow Vtach with a QRS >.200ms is always indicative of ____
hyperkalemia (amio will kill them - need to shift K)
In the second phase after a burn (36 hours-7 days) what type of electrolyte imbalances will you likely see?
hypernatremia, hypokalemia, hypophosphatemia, hypomagnesemia, hypocalcemia (reabsorption of cellular edema, urinary retention - release of ADH)
In the first phase after a burn (0-36 hours) what type of electrolyte imbalances will you likely see?
hyponatremia and hyperkalemia (dilutional state - giving fluids, vascular permeability, release of K)
3 common signs of neurogenic shock (in conjunction with suspected neuro injury)?
hypotension, bradycardia, peripheral vasodilation (flushed/red skin) (they are being controlled by parasympathetic nervous system, sympathetic isn't working/working correctly)
Myxedema coma is an extreme manifestation of _____
hypothyroidism
List two reasons for a decreased pulmonary capillary wedge pressure
hypovolemia vasodilation
When should you do a posterior 12 lead?
if you have reciprocal changes V1-V3 do posterior 12 lead - posterior 12 lead only needs 0.5mm or greater of ST elevation
What are bands?
immature neutrophils - suggests acute inflammatory/infectious process
List 2 problems that can be caused by early inflation of an IABP
increase in LVEDV, increase in LVEDP, premature closure of the aortic valve, aortic regurgitation, increased left ventricular wall stress
Fetal hypoxia and mechanical cord compression can cause ____ fetal heart rate variability.
increased (saltatory pattern)
Patients in thyroid storm will have ___ levels of free T3 and T4, and _____ levels of TSH
increased, decreased
To compensate for the emphysema disease process, the body ____ ventilations and ___ cardiac output.
increases, decreases
A mix of Dalton's and Boyle's law concepts would conclude that as altitude ______, atmospheric pressure decreases. Even though the pressure changes, the gas stays at the ____ proportions. Therefore, if increasing altitude, the partial pressure of oxygen (amount available in atmosphere) will ___.
increases, same, decrease
You identify a ____ wall MI. You should now do a V4R 12 lead.
inferior
ARDS is primarily caused by a large number of ____ mediators being released as well as a large amount of _____. Together these cause damage to the endothelial lining in the lung between the ____ and surrounding capillaries.
inflammatory, neutrophils, alveoli
Cushing syndrome causes
prolonged exposure to glucocorticoids or pituitary tumor
What is the antidote for heparin?
protamine sulfate
Troponin is a _____ essential for muscle contraction, is also a ____ binding site, and can only start being detected __-__ hours post injury.
protein, calcium, 2-3
What port do you infuse through primarily for the PA catheter?
proximal port (could also use inject port - classically blue)
The two heart valves responsible for allowing blood out of the ventricles that open/close in tandum
pulmonic and aortic
The heart valve responsible for maintaining diastolic pressure in the pulmonary artery
pulmonic valve -diastolic pressure in pulmonary artery needs to be higher than pressure in right ventricle
What do you do if you have an IABP pump failure?
quickly inflate and deflate balloon every 5 minutes using stopcock and syringe with 10cc less of helium than balloon volume is - this helps disrupt blood and prevent clots/emboli from forming (usually done when ballon is immobile for 30min or more)
List two contraindications/precautions to esmolol administration
reactive airway disease (essentially anybody on a beta agonist), bradycardia, AV blocks, cardiogenic shock, CHF
What ports do you avoid touching on a PA catheter?
red (balloon) and yellow (distal - can transduce if needed) *red and yellow kill a fellow*
If you have a metabolic acidosis, what would the normal response of the bodies respiratory system be?
respiratory alkalosis **moving opposite each other is a normal compensatory response**
List 3 causes of alkalosis
respiratory: anxiety, high altitudes, pregnancy, fever, initial states of PE metabolic: ingestion (OD of antacids), potassium wasting diuretics, gastric fluid loss (vomiting, NG suctioning)
Stagnant Hypoxia
results from the inability of blood to carry oxygen to tissues fast enough to sustain their needs (heart failure, circulatory shock, obstructive shock, PE)
List 3 considerations for hypothermia managment
rewarming, trial of glucose, thiamine, avoid excess movement, avoid NGT placement, be ready for wide array of dysrhythmias (especially v-fib - most protocols say shock once then just focus BLS if still in vfib until temp >30), defer medications until temp >30 (wont be able to circulate meds and then once warm all will start circulating together and can cause issues), monitor electrolytes, patients likely hypotensive from cold diuresis - will need fluid replacement, likely pressors
The SA node, AV node, right atrium, right ventricle, and posterior/inferior wall in 90% off the population are fed by what coronary artery?
right coronary artery
List 3 signs of hypocalcemia
seizures, muscle cramps, dysphagia, numbness and tingling in fingers/toes/perioral *chronic - brittle nails, dry skin, coarse hair, psoriasis, cataracts, chronic itching
List 3 contraindications for IABP therapy
severe aortic insufficiency, aortic aneurysm, aortic dissection, limb ischemia, thromboembolism
A ____ radio has a single channel for transmission.
simplex
If you have a bifascicular block and the patient goes into vtach/runs of vtach, what must you not treat them with and why?
sodium channel blockers (lido, amio, procainamide) - only option if needed is cardioversion if absolutely needed
What is the most commonly injured abdominal organ?
spleen (colon most common for penetrating trauma)
What is the scoring for eyes on the glasgow coma scale?
spontaneous=4 voice=3 pain=2 none=1
A patient on IABP therapy should have hemodynamic support medications titrated using what?
the mean pressure from the balloon pump
What is RDW (red cell distribution width)?
the measurement of variation of RBC sizes (normal 11-15%, most are same size)
dead space ventilation (V/Q mismatch)
the volume of air inhaled that does not take part in gas exchange because the alveoli are not perfused/poorly perfused (the Q or flow/cardiac output portion of V/Q mismatch)
What are the two components that make up minute volume (VE)?
tidal volume x respiratory rate
The length of time it takes for our lung units to fill or empty
time constant (typically in adults want at least a 3x constant (0.3 sec))
List 4 s/s of aspirin overdose
tinnitus, diaphoresis, n/v, vertigo, hyperventilation, agitation, hallucinations, lethargy, depressed DTRs, profound hypocalcemia (as patients go into metabolic acidosis derangement more of the aspirin will cross blood brain barrier and increase s/s)
What are the two things the distal port of a PA catheter is used for?
to draw a mixed SVO2 sample or to transduce the PA pressure
Congenital heart defect where pulmonary veins connect and drain into the right atrium instead of left
total anomalous pulmonary venous return
A patient presents in an acidotic state with associated hyperkalemia. What should be your treatment priority?
treat the acidosis - not the potassium (unless you are having cardiac related problems like irritability). Treating the acidosis (underlying cause) will cause the Hydrogen ions to shift out of the cell, and K to shift back in allowing the K to drop naturally.
List 3 potential reasons for increased Pplat
trendelenburg positioning, tension pneumo, abdominal compartment syndrome, pregnancy, pulmonary edema, ARDS, pulmonary effusions, obesity
List 3 s/s of malignant hyperthermia
trismus (tightening of jaw), increasing ETCO2, mixed acidosis, rhabdomyolisis, hyperkalemia, truncal or extremity rigidity
T/F: both aerobic and anaerobic metabolism start with glycolysis
true
T/F: Glucose pulls water out of the cell
true - it is a large hyperosmolar molecule
Heart defect where this is a single artery that arises from the ventricles instead of having separate aorta and pulmonary artery
truncus arteriosus
When evaluating unassisted vs assisted pressures in IABP therapy, which one should always be higher?
unassisted (think - reduced afterload in assisted, lower pressures)
Patients with a VQ mismatch, at least early on, will often have what type of ABG?
uncompensated respiratory alkalosis, PaO2 hypoxemia (patients tachypneic leading to the respiratory alkalosis)
Your square wave test on your art line reveals multiple oscillations after the square wave, what does this mean and what may be causing it?
under damping - caused by too much tubing or increased SVR (system over sensitive)
List 3 potential reasons for increased PIP
upper airway obstruction, suctioning, kinked ETT tube, kinked vent circuit, patient triggering - coughing, poor sedation, disease process - asthma, COPD, etc.
What is the number one cause of neonatal sepsis?
vaginal birth with group B positive mother (could also be maternal UTI, premature rupture of membranes, etc.)
What does a dicrotic notch represent?
valve closure (depends on location which valve - for ex: IABP is aortic valve, PA catheter is pulmonic valve)
List 3 considerations of management for an aspirin/salicylate overdose
ventilator management (matching what patient is doing - hyperventilation), fluid replacement with LR/NS to 1 ml/kg/hr goal, urinary alkalization (with IVF and bicarb) to help kidneys excrete salicylate through urine, monitor potassium level, GI decontamination (activated charcoal)
What does the T wave represent on an ECG?
ventricular repolarization
What are the two main issues with a hypoplastic left heart?
very small LV, very small incompletely formed aorta
What is the antidote for coumadin?
vitamin k, ffp