TEST EXAM FOR CRITICAL CARE PARAMEDIC LATEST VERSION

TEST EXAM FOR CRITICAL CARE PARAMEDIC LATEST VERSION Normal pH - CORRECT ANSWER-7.35-7.45 Normal CO2 - CORRECT ANSWER-35-45 Normal HCO3 - CORRECT ANSWER-22-26 (good dating age) Normal PaO2 - CORRECT ANSWER-80-100 Normal SaO2 - CORRECT ANSWER-> 95% Base (deficit/excess) - CORRECT ANSWER-(-2) - (+2) Buffer systems: Bicarb reaction time - CORRECT ANSWER-seconds Buffer systems: Lungs reaction time - CORRECT ANSWER-minutes Buffer systems: Kidneys reaction time - CORRECT ANSWER-hours to days Minute volume calculation - CORRECT ANSWER-Tidal volume x respiratory rate pCO2 >45 - CORRECT ANSWER-acidotic pCO2 <35 - CORRECT ANSWER-alkalotic HCO3 <22 - CORRECT ANSWER-acidotic HCO3 >26 - CORRECT ANSWER-alkalotic base deficit of < -4 - CORRECT ANSWER-indicator for the potential need for blood transfusion base deficit of < -19 - CORRECT ANSWER-indicates poor outcome (death likely) base deficit replacement formula - CORRECT ANSWER-0.1 x (-BE) x patient weight in kg = bicarb needed PO2 of 60 is roughly equivalent to a SaO2 of - CORRECT ANSWER-90% critical pH for intubation - CORRECT ANSWER-< 7.2 critical pCO2 for intubation - CORRECT ANSWER-> 55 critical pO2 for intubation - CORRECT ANSWER-< 60 number one cause of metabolic acidosis - CORRECT ANSWER-lactic acidosis (lactate > 4) CO2 is a byproduct of - CORRECT ANSWER-metabolism for every __ change in ETCO2, you should expect the pH to change __ in the ___________ direction. - CORRECT ANSWER-10, 0.08, opposite for every __ change in pH, you should expect the HCO3 to change __ in the ___________ direction. - CORRECT ANSWER-0.15, 10, same for every __ change in pH, you should expect the potassium to change __ in the ___________ direction. - CORRECT ANSWER-0.10, 0.6, opposite LEMON - CORRECT ANSWER-difficult intubation look, evaluate (3-3-2), mallampati, obstructions, neck mobility HEAVEN - CORRECT ANSWER-difficult intubation Hypoxia, extremes of size, anatomic challenges, vomit/blood/fluid, exsanguination, neck mobility issues ramping - CORRECT ANSWER-ear to sternal notch without ramping during intubation or transport causes a potential for - CORRECT ANSWER-decrease in functional reserve capacity, tidal volume, and preload Sellick's maneuver and BURP - CORRECT ANSWER-no longer recommended External laryngeal manipulation (ELM) - CORRECT ANSWER-current standard of practice bougie adult size - CORRECT ANSWER-15 Fr bougie pediatric size - CORRECT ANSWER-10 Fr bougie neonatal size - CORRECT ANSWER-6 Fr supraglottic devices - CORRECT ANSWER-provide little protection against aspiration ETT cuff pressure - CORRECT ANSWER-20-30 mmHg (25 is standard) gold standard of confirming ET placement - CORRECT ANSWER-chest X-Ray distal tip of ET - CORRECT ANSWER-2-3 cm (1 inch) above carina, at T3 or T4 7 p's for RSI success - CORRECT ANSWER-preparation, preoxygenation, pretreatment, paralysis with induction, protect/position, placement (with proof), post intubation management LOAD - CORRECT ANSWER-pretreatment for RSI lidocaine, opiates, atropine (infants), defasiculating dose fentanyl adult dose - CORRECT ANSWER-1 mcg/kg fentanyl onset - CORRECT ANSWER-3-5 mins fentanyl post intubation management - CORRECT ANSWER-0.5 - 1.5 mcg/kg every 5 minutes fentanyl post intubation management infusion - CORRECT ANSWER-1-3 mcg/kg/hour fentanyl reversal agent - CORRECT ANSWER-narcan etomidate adult dose - CORRECT ANSWER-0.3 mg/kg etomidate onset time - CORRECT ANSWER-15-45 seconds etomidate duration - CORRECT ANSWER-3-12 minutes etomidate cautions/contraindications - CORRECT ANSWER-hemodynamically unstable patients, adrenal suppression, shock patients, COPD/asthmatic ketamine adult dose - CORRECT ANSWER-1-2 mg/kg ketamine onset - CORRECT ANSWER-40-60 seconds ketamine duration - CORRECT ANSWER-10-20 minutes ketamine is preferred for - CORRECT ANSWER-asthmatic patients ketamine post intubation management - CORRECT ANSWER-0.5 - 1 mg/kg ketamine post intubation management infusion - CORRECT ANSWER-1-2 mg/kg/hour versed adult dose - CORRECT ANSWER-2.5-5 mg versed onset - CORRECT ANSWER-30-60 seconds versed duration - CORRECT ANSWER-15-30 minute duration versed post intubation management - CORRECT ANSWER-2-5 mg versed post intubation management infusion - CORRECT ANSWER-0.05 - 0.1 mg/kg/hour versed reversal agent - CORRECT ANSWER-flumazenil (romazicon) 0.2 mg propofol (diprivan) adult RSI dose - CORRECT ANSWER-1-2 mg/kg propofol (diprivan) adult maintenance dose - CORRECT ANSWER-25-50 mcg/kg/min propofol (diprivan) onset - CORRECT ANSWER-15-45 seconds propofol (diprivan) duration - CORRECT ANSWER-5-10 minutes propofol (diprivan) cautions - CORRECT ANSWER-hemodynamically unstable patients succinylcholine (anectine) - CORRECT ANSWER-depolarizing neuromuscular blocker agent succinylcholine (anectine) can cause - CORRECT ANSWER-fasciculations hyperkalemia succinylcholine (anectine) requires - CORRECT ANSWER-refrigeration succinylcholine (anectine) contraindications - CORRECT ANSWER-crush injuries, eye injuries, narrow-angle glaucoma, malignant hyperthermia, burns >24 hours old, hyperkalemia, Guillain- Barre, Myasthenia gravis succinylcholine (anectine) adult dose - CORRECT ANSWER-1-2 mg/kg (max 150) succinylcholine (anectine) onset - CORRECT ANSWER-< 1 minute succinylcholine (anectine) duration - CORRECT ANSWER-4-6 minute duration malignant hyperthermia - CORRECT ANSWER-rapid body temperature increase and increased ETCO2 malignant hyperthermia treatment - CORRECT ANSWER-Dantrolene Sodium (Dantrium) 2.5 mg/kg rapid Rocuronium (Zemeron) - CORRECT ANSWER-non-depolarizing neuromuscular blocking agent Rocuronium (Zemeron) adult RSI dose - CORRECT ANSWER-0.6 - 1.2 mg/kg Rocuronium (Zemeron) maintainance dose - CORRECT ANSWER-0.1 - 0.2 mg/kg every 20-30 minutes Rocuronium (Zemeron) onset - CORRECT ANSWER-< 2 minutes Rocuronium (Zemeron) duration - CORRECT ANSWER-30 - 60 minutes Rocuronium (Zemeron) requires - CORRECT ANSWER-refrigeration Rocuronium (Zemeron) reversal agent - CORRECT ANSWER-Sugammadex (Bridion) 16 mg/kg Vecuronium (Norcuron) - CORRECT ANSWER-non-depolarizing neuromuscular blocking agent Vecuronium (Norcuron) use - CORRECT ANSWER-used after sux or rox to keep the patient paralyzed Vecuronium (Norcuron) adult dose - CORRECT ANSWER-0.15 mg/kg Vecuronium (Norcuron) adult maintenance dose - CORRECT ANSWER-0.01 - 0.1 mg/kg Vecuronium (Norcuron) does not require - CORRECT ANSWER-refrigeration Vecuronium (Norcuron) onset - CORRECT ANSWER-90-120 seconds Vecuronium (Norcuron) duration of action - CORRECT ANSWER-60-75 minutes RSI for hemodynamically unstable patients - CORRECT ANSWER-1/2 the induction dose, double to paralytic SALAD - CORRECT ANSWER-Suction assisted laryngoscopy airway decontamination under 8 years old - CORRECT ANSWER-needle cricothyrotomy tidal volume (Vt) - CORRECT ANSWER-how much air the patient breathes in a normal breath Inspiratory Reserve Volume (IRV) - CORRECT ANSWER-Amount of air that can be forcefully inhaled after a normal tidal volume inhalation Expiratory Reserve Volume (ERV) - CORRECT ANSWER-Amount of air that can be forcefully exhaled after a normal tidal volume exhalation Vital Capacity (VC) - CORRECT ANSWER-TV + IRV + ERV Residual Volume (RV) - CORRECT ANSWER-amount of air left in lungs after maximum expiration Total Lung Capacity (TLC) - CORRECT ANSWER-RV + VC (TV + IRV + ERV) Dead space - CORRECT ANSWER-the surfaces of the airway that are not involved in gas exchange (anything other than alveoli) Dead space formula - CORRECT ANSWER-2 ml/kg central chemoreceptors - CORRECT ANSWER-medulla/pons, driven by CO2 peripheral chemoreceptors - CORRECT ANSWER-aortic arch/carotid bodies, driven by O2 Respiratory patterns: Apneustic - CORRECT ANSWER-deep, gasping inspiration brief release decerebrate posturing Respiratory patterns: Ataxic - CORRECT ANSWER-irregular poor prognosis Respiratory patterns: Biots - CORRECT ANSWER-quick shallow respirations, regular periods of apnea head trauma, cva Respiratory patterns: Cheyne-Stokes - CORRECT ANSWER-gradual increasing deep, fast with gradual decrease into temporary apnea decorticate posturing, Cushings Respiratory patterns: Kussmaul - CORRECT ANSWER-deep, rapid DKA gold standard for oxygenation - CORRECT ANSWER-pulse ox (SPO2) gold standard for ventilation - CORRECT ANSWER-capnography (ETCO2) number one cause of iatrogenic death in US - CORRECT ANSWER-ventilator acquired pneumonia (VAP)