Critical Care Paramedic Exam Study Guide Questions And Answers

Critical Care Paramedic Exam Study Guide Questions And Answers So with MI, likely pressure due to occlusion in coronary artery, how to take pressure off? - ANSWER --need to get pressure off, not perfusing endocardial wall well, -Nitro and MS reduce preload -Goal is to decrease intraventricular pressures during diastole -Use left ventricular end diastolic pressure, which is the rough equivalent of pulm. capillary wedge pressure Coronary Perfusion Pressure= - ANSWER -dbp-pcwp Unstable Angina on Labs - ANSWER -Pos Cardiac Markers but no 12 lead changes Non-Stemi on labs - ANSWER -Pos Cardiac Markers and st-depression or dynamic t-wave changes Trend: Transmural vs. Endocardial - ANSWER -q-wave vs. non-qwave, Stemi vs. non-stemi IO Stabilization - ANSWER -3-cuts of tape -bulky dressings -gauze Tips for Peds IO Insertion - ANSWER -under 10 kilos, be careful you don't go through really? Adequate ventilations per minute... - ANSWER -2!!! but 10 is a bonus, don't hyperventilate! Instead of EC - ANSWER --3 airways -mask without bag -two thumbs and fingers jaw thrust Cardiac Enzymes - ANSWER -Myoglobin-first to elevate, hard to distinguish MI Ck-MB-Cardiac Ck, peaks after 18 hours Trop I, stays elevated after starts, but after CkMb If pt has elevated CkMB and Trop, we are late in the Game When you think of Septal/Anterior Wall Mi's Think... - ANSWER -Papillary Muscle Involvement and possible Flash PE (papillary muscle not pulling tendon of chordae to close mitral valve) If inferior Wall MI, we want to know? - ANSWER -how high? is there R. Ventricular involvement, move lead 4 over.. If every rhythm possible MI? - ANSWER -AV Node Involvement, need coronary vasodilation and preload St-Elevation means.. - ANSWER -Transmural, has progressed across muscle, -1mm in two anatomically contiguous leads (same region of heart), or 2mm in single lead a q wave must be - ANSWER -first neg. deflection is the q wave significant? - ANSWER -1/3 qrs amplitude, ST depression can signify? - ANSWER -Transmural somewhere else, sub-endocardial wall MI, has not progressed yet Which Leads to where? - ANSWER -II, III, AVF=RCA (inferior) V1,V2=Septal, v2-6=lateral/anterior I, AVL-Also lateral For Posterior Wall - ANSWER -Flip EKG upside down and look at anterior wall leads Dilt Drip - ANSWER -For Afib RVR and SVT, titrate up from 5mg/hr to 15mg/hr Dopamine Drip - ANSWER -Start around 2mcg/kg/min, and titrate up to around 20, dobutamine similar Toradol works for - ANSWER -Fever, Pain, 30mg, can go 30-60 IM Propofol Drip - ANSWER -5-50 mcg/kg/min Phenergan Dose - ANSWER -12.5 to 25 mg IV, may repeat in 10 Zofran Dose - ANSWER -4-8 mg if not actively vomiting, Oxytocin - ANSWER -10 units IM after placental delivery, For HTN and Aortic Dissection, starting dose for labetalol - ANSWER -20mg over 2 mins, double dose and repeat in ten HTN crisis is defined by...(caution) - ANSWER -sustained Sys over 180 and Diastolic over 120, we do not want to drop MAP more than 25% in 30-60mins, keep map above 90, if MAP is b/t 130-150 start labetalol Calculate MAP - ANSWER -Systolic + 2x(Diastolic)/3 Lido and Head Injury - ANSWER -Pre-Tx to blunt Catecholamine response Elevate Head in Head Injury - ANSWER -30 degrees if possible to improve jugular venous outflow Hyperventilation with Head Injury - ANSWER -Signs of active herniation (unequal pupils, lateralizing motor signs), keep PaCO2 30-35mmhg Pre Tx RSI Asthma - ANSWER -Lidocaine 1.5 to 2 mg/kg Sux Dose - ANSWER -1.5 to 2mg/kg adults and Peds Kids Less than 1, pre Tx with - ANSWER -Atropine, .02mg/kg, max .5mg Again, Ketamine Induction - ANSWER -1.5mg/kg (same for Peds) Hemodynamically unstable Ketamine Maintenance Sedation - ANSWER -1mg/kg fentanyl analgesia, may repeat - ANSWER -every 30 maintenance of versed, up to 5mg single dose - ANSWER -.1mg/kg (adult and Peds) Before Admin. Lasix for CHF - ANSWER -check blood OSM, formula=2xNA +BUN/2.8+Glu/18, if no labs withhold lasix, Serum OSM less than 270, give 10mgSIVP NTG for CHF - ANSWER -.4mg SL until drip starts q 5mins, if diastolic is below 60-no mas, start drip at 80mcg/min and titrate