AIR METHODS CRITICAL CARE EXAM(QUESTIONS AND ANSWERS)

AIR METHODS CRITICAL CARE EXAM(QUESTIONS AND ANSWERS) What is the most reliable method of confirming and montioring correct placement of an ET tube? - CORRECT ANSWER-Continuous waveform capnography The upper airway consists of... - CORRECT ANSWER-Nose, Mouth, Jaw, Oral Cavity, Pharynx, and Larynx No gas exchange occurs here __________, it's called ____________. - CORRECT ANSWER-Nose to terminal bronchioles, anatomical dead space. (2ml/kg of inspired tidal volume) They conduct airflow towards gas exchange units. Crycothyroid membrane - CORRECT ANSWER-between thyroid and cricoid, avascular structure that connects the thyroid and cricoid cartilage. Site of CRiCOTHYROTOMYan emergency opening of the airway. A PaCO2 greater than 45 mmHg indicates: A. Metabolic acidosis. B. Metabolic alkalosis. C. Respiratory acidosis. D. Respiratory alkalosis. - CORRECT ANSWER-C. Respiratory acidosis PaCO2 normal range - CORRECT ANSWER-35-45 mm Hg Less than 35 likely means hyperventilation Tracheal deviation AWAY from the affected side, decreased breath sounds, and hyperresonance... What's happening? - CORRECT ANSWER-Tension pneumothorax In a tension pneumothorax tracheal deviation goes in what direction? - CORRECT ANSWER-AWAY from affected side. Normal mean pulmonary artery pressure - CORRECT ANSWER-10-20 mmHg Pulmonary hypertension is a mean PA pressure greater than... - CORRECT ANSWER- (PAm) greater than 20 Primary pulmonary hypertension - CORRECT ANSWER-Idiopathic genetic disorder caused by abnormal structure of the pulmonary blood vessels Name three causes of secondary pulmonary hypertension.. - CORRECT ANSWER-1. Passive PH- the result of back pressure. Mitral Stenosis, LV systolic failure. 2. Active PH- Constriction of the pulmonary circuit Increased volume in pulmonary circuit (i.e. congenital heart disease) 3. Obstruction as in Chronic recurrent PE TNP of the Pregnant patient - CORRECT ANSWER-Resuscitation priorities are the same. The best way to take care of the baby is to take care of mama Mechanisms of injury and biomechanics the most common cause of maternal injury is... - CORRECT ANSWER-Blunt trauma caused by MVC. Second is BT caused by falls, 3rd is violence fetal distress is an early sign of maternal distress... Why? - CORRECT ANSWERCatecholamine mediated vasoconstriction resulting from blood loss shunts blood away from the fetus to the mom. Fetal hypo perfusion is evidenced by.... - CORRECT ANSWER-Fetal tachycardia (140 to 160+) and fetal bradycardia The FRC in a pregnant patient is.... - CORRECT ANSWER-Reduced by the gravid uterus lifting the diaphragm. chest tube placement in a pregnant patient is 1-2 spaces higher - CORRECT ANSWERBecause of the lifted diaphragm What is the cause of physiological anemia in pregnant patients? - CORRECT ANSWER-Hemodilitional anemia occurs. Plasma volume increases 30-50%. Preterm Labor (PTL) - CORRECT ANSWERabruptio placentae - CORRECT ANSWER-premature separation of the placenta from the uterine wall On a pregnant patient... - CORRECT ANSWER-Chest compressions must be higher on the sternum. Any preg patient 20 weeks pregnant or more with a uterus above the umbilicus should have the uterus left laterally displaced during compressions to avoid aortocaval compression. A 15 degree tilt of the long board or lateral displacement. What is the Maternal Fetal Triage Index? - CORRECT ANSWER-A valid reliable 5 level triage tool that may assist in the triage of obstetric trauma patients. Displacing the uterus off the vena cava can improve CO by - CORRECT ANSWERapproximately 30%! Continuous fetal monitoring is recommended... - CORRECT ANSWER-for all pregnant patients 20 or more weeks gestation... or (uterus above belly button). Fundal height measurement - CORRECT ANSWER-equals the approximate gestational age in weeks, until week 32. Belly button is 20 weeks Height of last rib is 26 weeks costal margin is 36 weeks Any fundal height indicating 23 or more weeks... - CORRECT ANSWER-at the last rib and above is consistent with a viable fetus. What type of blood should a pregnant trauma patient receive? - CORRECT ANSWERO-NEG baybay. Initiate cardiotocography in any mother - CORRECT ANSWER-20 or more weeks gestation, must be monitored for at least 6 hours. What is the serum lab test that detects fetal red cells in the maternal circulation? - CORRECT ANSWER-Kleinhauer Bette KB serum test. This lab is used to determine if hemorrhage of fetal blood through the placenta and into maternal circulation. KB test is an important detector of abruptio placentae, preterm labor and need to administer Rh negative globulin when mom is Rh negative and fetus is Rh positive. Continue fetal monitoring for a minimum of ---- hours for any viable pregnancy and up to _____ hours if there is abdominal trauma - CORRECT ANSWER-6..... 24 Sonography has __________ for diagnosis placental abruption, - CORRECT ANSWERPOOR.... they miss 50-80% of abruptions. In addition to routine labs a - CORRECT ANSWER-Prothrombin (PT ) and PTT and serial coags should be drawn. Beta Human Chorionic gonadotropin (BHCG) Measure and record fundal height every - CORRECT ANSWER-30 minutes. Pediatric Mechanisms of injury and biomechanics - CORRECT ANSWER-Blunt trauma MVC > suffocations > drownings > fires/burns. No. 1 cause of fatalities is TBI. Primary Survey/ Resuscitation - CORRECT ANSWER-Survival rates in pediatric emergency can be directly correlated with 1.RAPID AIRWAY MANAGEMENT, 2.INITIATION OF VENTILATORY SUPPORT, AND 3.EARLY RECOGNITION OF AND EARLY RESPONSE TO INTRA abdominal AND intracranial hemorrhages A STEMI is a __________ resulting from a _________. - CORRECT ANSWERComplete Occlusion of a coronary artery caused by a ruptured Plaque leading to blood clot formation in the coronary. STEMI diagnosis - CORRECT ANSWER-Chest pain + positive cardiac enzyme (TROP. >0.4), and --ST segment ELEVATIONS greater than 1 mm in two or more contagious leads V1-V6 -Reciprocal (depressions) changes in leads II, III, AVF STEMI EKG findings - CORRECT ANSWER-STEMI STEMI EKG findings more - CORRECT ANSWER--St elevations > 1mm in Limb leads: 1, II, III, avF, avL -St elevations > 2mm in precordial leads (v1-v6) AND/OR -NEW LBBB Contiguous leads with reciprocal changes in opposite leads First degree Heart Block EKG - CORRECT ANSWER-AV block Prolonged PR Interval greater than 120-200 ms second degree heart block type 1 Wenkebach - CORRECT ANSWER-AV block in which occasional electrical impulses from the SA node fail to be conducted to the ventricles. PR interval progressively lengthens greater than 120-200ms + dropped beats. Maternal cardiopulmonary arrest...If any moribund patient is 24 weeks or more perimortem c section must be considered. AHA recommends c section initiation within... - CORRECT ANSWER-4 minutes... delivery with in 5 minutes of any unsuccessful maternal resuscitative attempts. Second Degree Heart Block (Mobitz II) - CORRECT ANSWER-= Damage AT av node - moderate • PR-interval is normal; QRS complexes are dropped erratically • ALL must have a pacemaker in the next 72 hrs. STEMI Nitro gtt - CORRECT ANSWER-5-10 mcg per minute Titrate by 10 mcg max dose 300 mcg per minute How do you mix epi? - CORRECT ANSWER-Mix 1 mg in 1 L NS or D5W or LR for a concentration of 1 mcg/ ml What's the epi dose for hypotension s/p arrest? - CORRECT ANSWER-0.1 - 0.5 mcg/kg/min What is the epi dose for anaphylaxis? - CORRECT ANSWERPediatric Epinephrine dose - CORRECT ANSWERPALS 2020 update - CORRECT ANSWER-AHA 2020 BASIC BP Diastolic BP of at least 25mmhg in infants and at least 35 mmhm in children correlates with better outcomes. PALS Brady with a pulse - CORRECT ANSWER-Assess airway, breathing, mental status Most common cause is hypoxia! could also be hypothermia and or medications. s/s of shock? AMS? hypotensive? Start CPR if any of these Always start CPR if HR < 60 bpm iv access Give Epi 0.01 mg/kg (0.1ml of 0.1mg/ml solution) Repeat Q 3-5 minutes Initial management of pediatric respiratory distress or Failure A - CORRECT ANSWER1. A-ABC. Support open airway: Comfort or Head tilt chin lift. Jaw thrust. Clear airway if indicated. (suction nose or mouth if indicated) Consider OPA or NPA. IDENTIFY type and Severity of respiratory problems Initial management of pediatric respiratory distress or Failure B - CORRECT ANSWER2. B-Monitor Spo2 withPulse ox. Provide high concentration O2, via non rebreather -Administer inhaled meds: Albuterol or Epi. as needed -Assist ventilation with child ambu + o2 if needed. Prepare for intubation if needed. Initial management of pediatric respiratory distress or Failure C - CORRECT ANSWER3.C-Monitor heart rate, rhythm and BP. Establish IV/IO access. and fluids/ meds as needed. Evaluate Identify Intervene What is an upper airway obstruction? - CORRECT ANSWER-Interruption in airflow through nose, mouth, pharynx, or larynx. The large always outside the thorax. PALS What causes upper airway obstruction? - CORRECT ANSWER-Airway Swelling (anaphylactoid rx) ,Infection r/t croup Aspirated foreign body enlarged tonsils or adenoids Decreased level of consciousness GCS of 8?