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Critical Care/Flight Paramedic Exam
babinski reflex - ANS>extension and spreading of toes when bottom of foot is stroked. sign of nervous system lesion battles sign - ANS>bruise behind ear, basilar skull fracture becks triad - ANS>jvd, muffled heart tones, hypotension. from cardiac tamponade brudzinski sign - ANS>flexion of the neck results in flexion of the hip. meningitis coopernails sign - ANS>ecchymosis on perineum, labia, scrotum. sign of pelvis fracture cullens sign - ANS>bruising around umbilicus. Sign of pancreatitis or ectopic pregnancy grey turners sign - ANS>discoloration of skin around flank. sign of pancreatitis
hammans sign - ANS>crunching sound of heart with asynchronous heart beat. sign of mediastinal emphysema/tracheobronchial disruption kehrs sign - ANS>left shoulder pain associated with splenic rupture kernigs sign - ANS>pain to knee extension when hip is at 90 degrees. sign of meningitis levines sign - ANS>pain with clutched fist over midline of chest. sign of cardiac chest pain mcburneys sign - ANS>tenderness 2/3 the distance between umbilicus and ileum. sign of appendicitis muphys sign - ANS>pt unable to take deep breath on inspiration with deep palpation beneath right coastal margins. sign of gall bladder issues S2 "dub" heart tones - ANS>aortic and pulmonary valve closure s1 "lub" sound - ANS>bicuspic/tricuspid valve closure stroke volume is affected by - ANS>preload, afterload, contractility
what does the dicrotic notch symbolize? - ANS>aortic valve closing saline from ART line should infuse at what rate - ANS>3ml/hr normal central venous pressure (CVP) - ANS>2- when utilizing a swan ganz catheter, never exceed ____mL of air in distal balloon - ANS>1. coronary perfusion pressure calculation - ANS>PAWP-DBP (should be 50-60) PAWP range - ANS>8- PVR range - ANS>50- PA pressure - ANS>15-25 systolic, 8-15 diastolic SVR range - ANS>800-
what does PVR signify - ANS>right heart afterload, pulmonary vascular resistance what is PCWP - ANS>same as pAWP left heart preload is also called - ANS>left ventricular end diastolic pressure LVEDP what is CI - ANS>same as CO what happens to pressures during cardiogenic shock - ANS>decreased cardiac output (CO/CI), increased everything else what happens to pressures during hypovolemic shock - ANS>decreased SVR, increased everything else what happens to pressures during anaphylactic shock - ANS>increased CO/CI, decreased everything else when should PAWP readings be taken - ANS>at the end of exhalation
do you have to manually purge the IABP at altitude? - ANS>no for a patient in A-fib what is the best trigger for the IABP? - ANS>pressure mode normal value of ICP - ANS>5- ICP above what mmHg has high mortality? - ANS>above 20 normal cerebral perfusion pressure (CPP) - ANS>70- ICP monitoring waveform looks like - ANS>3 humps, each lower than the last P1 on ICP waveform - ANS>systole P2 of ICP waveform - ANS>compliance of brain (percussion wave) P3 of ICP waveform - ANS>dicrotic notch
what does P2 elevation on ICP waveform signify? - ANS>poor compliance, increasing ICP hyperglycemia in brain injuries - ANS>makes it worse hyponatremia in brain injuries - ANS>associated with brain edema subdural hematoma CT presentation - ANS>looks like a crescent moon epidural hematoma CT presentation - ANS>lens shape central cord syndrome - ANS>upper extremity weakness that is greater than lower extremeties anterior cord syndrome - ANS> most common cause of encephalitis - ANS>Herpes simplex 1 status epilepticus is characterized by - ANS>one seizure lasting longer than 5 minutes or recurrent seizures longer than 30 minuets
what is the only shock with a high cardiac index? (CI/CO) - ANS>septic what does it mean to have an INCREASED anion gap? - ANS>metabolic acidosis what is most likely injured in a diving accident? - ANS>C5 and C Newton's second law - ANS>Mass(force)=acceleration Newton's first law - ANS>an item in motion will remain in motion unless acted on by an outside force Newton's third law - ANS>for every action there is an equal and opposite reaction what is the most important predictor in GSW damage? - ANS>velocity kehrs sign is a sign of a - ANS>splenic rupture chance fracture - ANS>T12-L1. caused by rear impact C2 fracture - ANS>hangmans fracture
C1 fracture - ANS>jeffersons fracture collee fracture - ANS>bilateral distal radial fractures from catching yourself while falling most commonly injured hollow organ in abdominal trauma - ANS>small intestine what is the most dangerous pelvic fracture - ANS>vertical shear Le Forte I - ANS>horizontal across maxilla Le Forte II - ANS>bridge of nose and around mouth, usually from downward blow to nose Lefort III - ANS>craniofacial dissociation for femoral vein cannulation, is artery or vein more lateral? - ANS>artery is more lateral, vein is medial do pRBC and FFP require ABO compatibility - ANS>yes
anion gap - ANS>12 +- 4 RBC count - ANS>5 million/mL osmolality # - ANS>275 - 295 what is proper ET placement? - ANS>2-3 cm above carina, level of T2- T4, 1 inch above carina what is anectine - ANS>succinylcholine target for ET cuff pressure - ANS>20- what is LOAD - ANS>pneumonic for pre RSI meds. Lidocaine, opiates, atropine, defasciculation dose 7Ps of RSI - ANS>preparation, preoxygenate, pretreatment, paralysis, protect and position, placement, post intubation pneumonic for pressure alarms - ANS>DOPE
normal tidal volume - ANS>4-8 ml/Kg normal minute ventilation volume - ANS>4-8 lpm VE symbolizes - ANS>ventilation volume what is important to monitor when using pressure control mode on a ventilator? - ANS>VTE (expired tidal volumes) severe hypothermia and what happens - ANS>32C, 89.6F. shivering stops hypothermia is defined as - ANS>core temp below 95 primary cation lost in heat injuries - ANS>sodium what ODs can cause diabetes insipidus? - ANS>keppra, pheytoin (dilantin) diabetes insipidus treatment - ANS>DDAVP iron overdose treatment - ANS>deferoxamine
what drugs are tocolytics - ANS>mag and terbutaline normal fetal heart rate variability - ANS>15- antidote for mag toxicity - ANS>calcium HELLP syndrome - ANS>in pregnancy. Hemolysis, Elevated Liver enzymes, Low Platelets. has jaundice and RUQ pain treatment for HELLP - ANS>steroids to stimulate fetal lung maturity how to suction neonate - ANS>mouth before nose most common cause of neonatal sepsis - ANS>group B strep abnormality in newborns where bone blocks the nasal passage - ANS>choanal atresia hyaline membrane disease - ANS>neonatal ARDS. causes surfactant deficiency
omphalocele - ANS>protrusion of viscera what has worse outcome, omphalocele or gastrocschisis? and why? - ANS>omphalocele, these pts typically have underdeveloped lungs as well treatment for neonatal hypoglycemia - ANS>2ml/kg of D what do hematomegaly and cardiomegaly in a neonate signify, and what is the treatment? - ANS>signify CHF, treatment digoxin/digitalis ventricular septal wall defect is an example of - ANS>right to left shunt if a neonate deteriorates after oxygen administration what does this mean - ANS>they need the patent ductus arteriosus to live (PDA. it is closed by oxygen) what drug keeps the PDA open - ANS>prostaglandin E what forms after closure of the PDA? - ANS>ligamentum arteriosum if a child squats down to improve SVR this is a sign of - ANS>tetralogy of fallot
asterixis - ANS>flapping of hands, associated with liver failure barodontalgia happens when - ANS>on ascent barotitis media happens when - ANS>on descent treatment for hypothyroid - ANS>synthroid chovsteks sign - ANS>hyper reactive face muscles. sign of calcium deficiency tell me about BNP and levels - ANS>B type Natriuretic Peptide is a measure of heart failure. less than 100, no failure. greater than 300, mild. greater than 600 moderate, greater than 900 severe what is uremic pericarditis - ANS>post dialysis pericarditis a base deficit >-4 indicates - ANS>need for blood transfusion SaO2 90, 80, 70 corresponds to to PaO2 of - ANS>60,50,
what pH and temp shift oxyhemoglobin curve to the left - ANS>decreased temp, decreased pH what pH and temp shift oxyhemoglobin curve to the right - ANS>increased temp, increased pH what does partially compensated mean - ANS>ph, Co2 and HCO3 are all outside of normal range CO2 change 10, what does this do to pH and K+? - ANS>pH goes 0.8 in opposite direction, K+ goes 0.5 in same direction pH increases 0.15, what does this do to HCO3? - ANS>changes 10 in same direction critical values for intubation - ANS>pH less than 7.2, CO2 greater than 55, PaO2 less than 60 number one cause of metabolic acidosis - ANS>lactic acidosis peds ET tube size - ANS>(16+age)/ age for needle cric - ANS>8yo and below
