Air Methods Critical Care Exam Practice Questions And Answers | Latest Updated 2023/2024 (GRADED 100%)

Air Methods Critical Care Exam Practice Questions And Answers | Latest Updated 2023/2024 (GRADED 100%). PEEP (positive end expiratory pressure) - ANSWER--Causes increased pulmonary vascular resistance -Can cause hypotension over 15 cmH2O -Normal: 5 cmH2O - lowest pressure the lungs will see steps in resuscitation of the neonate - ANSWER-Dry, warm, position to open airway, suction mouth then nose Tactile stimulation (HR<100 or apnea/IR breath rub back and put) Oxygen near the face Bag valve mask - unresponsive to tactile stim within a few sec (40-60bpm) reposition head, reapply mask, suction again prn, if no response in 30 sec Intubate - if HR < 60 after PPV for 30 sec, then Chest compressions - 3:1 ratio (90 compressions / 30 breaths) Drugs - epinephrine 0.1-0.3ml/kg of 1:10,000, through et tube or (preferably) through umbilical venous line, volume loss give 10ml/kg NS pulmonary contusion - ANSWER-Chest pain bruising over sternum Progressive dyspnea decreased breath sounds on one side rales low sats despite being on o2 hemoptysis irregular pulse-dysrthymia ruptured diaphragm - ANSWER-abd contents herniate into the thoracic cavity compressing the lung s/s: dyspnea, dysphagia, abd pain, sharp epigastric or chest pain radiating to L shoulder (Kehr sign), bowel sounds heard in the lung fields on injured side, decreased breath sounds on injured side. Tracheobronchial injury - ANSWER-1. hemoptysis 2. subcutaneous emphysema 3. air leak (PNEUMOTHORAX) + PNEUMEDIASTINUM even after chest tube placement*** - advance ETT below level of injury into Right mainstem esophageal perforation - ANSWER--fever -hematemesis Fat embolus - ANSWER-can form when a long bone is fractured and fat cells from yellow bone marrow are released into the blood -fever -rash after fracture Blood loss from humerus fracture - ANSWER-750 ml blood loss from femur fracture - ANSWER-1500 ml PAWP (pulmonary artery wedge pressure) - ANSWER-- Looks at the left side of the heart - If elevated can indicate pulmonary congestion, CHF, cardiogenic shock - Do not keep wedged for more than 30 seconds - Make sure balloon is deflated and have patient cough forcefully -Normal: 8-12 Adult ETT depth - ANSWER-3 x ETT size or average 19.23 cm Peds ETT depth - ANSWER-10 + age in years (cm) Neonate ETT depth - ANSWER-6 + wt in kg (cm) Adjust vent to change Co2 - ANSWER-adjust rate and tidal volume Adjust vent to change oxygenation - ANSWER-adjust PEEP, PAP infant rule of nines - ANSWER-Head and neck - 21% Each arm - 10% chest/stomach - 13% back - 13% butt/genitals - 6% each leg - 13.5% Sodium Bicarbonate - ANSWER--acidosis -drug choice for cyclic antidepressant OD -KG/4 x base deficit = mEq needed Digoxin - ANSWER--cardiac glycoside -can cause hypokalemia -inotropes -pediatric dose: 0.1 mg/ml -adult 0.25 mg/ml treatment for fetal distress - ANSWER--Left lateral recumbent position -O2 -Correct contributing factors -keep reassessing CHF considerations - ANSWER--many are relatively hypovolemic -be careful with diuretics CVP catheter placement outside line markers - ANSWER-RA/CVP: 25-30 cm RV: 35-45 cm PA: 50-55 cm Central Cord Syndrome - ANSWER--loss of function in upper extremities caused by injury to the middle portion of the spinal cord -varying degrees of sensory loss Brown-Sequard Syndrome - ANSWER-Hemi-section of the cord - ipsilateral (same side) spastic paralysis and loss of position sense - contralateral (opposite side) loss of pain and thermal sense Anterior Cord - ANSWER--loss of motor function, pain, pinprick, and temp bilaterally below lesion -proprioception and light touch are preserved Autonomic Dysreflexia - ANSWER--urinary retention, massive increase in sympathetic tone which can cause HTN -treated by foley Adult urine output per hour - ANSWER-30-50 ml Peds Urine output per hour - ANSWER-1-2 ml/kg/hr Normal adult blood volume - ANSWER-70 ml/kg Peds blood volume - ANSWER-80 ml/kg Mild Hypothermia - ANSWER--32-36 degrees Celcius -decreased HR CVP (central venous pressure) - ANSWER--Measures preload (right atrial pressure) -Norm: 2-6 mmHg - Use proximal port Basic natriuretic peptide (BNP) - ANSWER--heart failure marker that measures this level by an over distention of the heart ->500 = HF Most common spontaneous recurrance - ANSWER-anterior shoulder Most common dislocation - ANSWER-hip First adjustment on ventilator - ANSWER-TV first, not rate drugs for AAA - ANSWER-Nipride and Beta Blockers Kehr's sign - ANSWER--Referred pain down the left shoulder -indicative of a ruptured spleen or ectopic pregnancy Kernig's sign - ANSWER--Sign of bacterial meningitis -positive with back, leg pain on knee extension Brudzinski's sign - ANSWER--Back, leg pain on neck flexion -Possible Bacterial Meningitis or subarachnoid bleed Hamman's sign - ANSWER-- Crunching sound heard with auscultation over the anterior chest synchronized with heartbeat - tracheobronchial injury Steeple sign - ANSWER-- Possible croup (laryngotracheobronchitis) -found on A/P xray neck view Thumbprint sign - ANSWER-Radiographic appearance on lateral x-ray that signifies epiglottitis Acidosis - ANSWER-- pCo2 up = pH down - pH down = HCO3 down - pCo2 > 45 - pH < 7.35 - HCO3 < 22 Alkalosis - ANSWER-- pCo2 down = pH up - pH up = HCO3 up - pCo2 < 35 - pH > 7.45 - HCO3 > 22 Primary cause of death with ventilator dependent patients - ANSWER-Ventilator acquired pneumonia Mannitol (Osmitrol) - ANSWER-- 1-2 g/kg -reduce ICP -reduce IOP -promote diuresis for ARF -remove (excrete) toxic substances Ativan - ANSWER--seizures - 1-2 mg - max 4mg Ketamine - ANSWER-- Induction agent of choice with bronchospastic patient -RSI - 1 - 2 mg/kg - 40-60 second onset - 10 - 20 minute duration - combative: 5mg/kg IM or IN - pain: 0.1 - 0.2 mg/kg IV - increase oral secretions - caution with HTN - may cause laryngospasms Consensus formula - ANSWER-- LR/NS 2-4ml x kg x TBSA% - give half over the first 8 hours from burn time - give half over the next 16 hours Parkland Formula - ANSWER-- LR/NS 4ml x kg x TBSA% - give half over the first 8 hours from burn time - give other half over next 16 hrs - use for >20% TBSA in adults and >10% in peds Burn hypotension considerations - ANSWER--Hypotension is a late sign in burns -If comes in with hypotension then consider other traumatic causes like hemothorax, cardiac tamponade, neurogenic shock, internal abdominal or pelvic bleeding Adult rule of nines - ANSWER-- Head/neck: 9% - each arm/hand: 9% - chest: 9% - abdomen: 9% - back: 18% - each leg: 18% - genitals: 1% Pediatric rule of nines - ANSWER-- Head: 18% - chest/abd: 18% - Back: 18% - Full arm: 9% - Full leg: 14% Bowel sounds in chest cavity - ANSWER--Diaphragmatic rupture -Most common in the left chest Dehydration raises serum? - ANSWER-Sodium Normal sodium; 135-145 Treat HTN if blood pressure is over - ANSWER-- 220 systolic - MAP over 130 ARDS (acute respiratory distress syndrome) - ANSWER-- PCWP <18 - CXR with bilateral pulmonary infiltrates - PaCO2:FiO2 ratio <200 - increase PEEP Normal FHR - ANSWER-120 - 160 Passive Rewarming - ANSWER-- Mild hypothermia only - Up to 1 degree/ hr with blankets or heater Active rewarming - ANSWER-application of an external heat source to rewarm the body of a hypothermic patient Warm and dead temp - ANSWER-32 degrees Heat stroke - ANSWER-over 42 degrees Grey Turner's sign - ANSWER-- Flank bruising - Retroperitoneal bleeding Moderate Hypothermia - ANSWER-- 29-32 degrees -loss of shivering - ALOC Severe hypothermia - ANSWER-- 20-28 C - Coma, VF Common 2 major causes of heat loss - ANSWER-- radiation - evaporation Thermoregulation ceases at - ANSWER-28 degrees C Glucagon - ANSWER-- drug choice for beta blocker OD Fentanyl - ANSWER-- 1 mcg/kg - 3-5 minute onset - 30 - 60 minute duration - Induction agent RSI (analgesic) - causes CNS depression - can cause muscle rigidity if given too quickly or too much Dantrium - ANSWER-treatment for malignant hyperthermia Sandostatin (octreotide) - ANSWER--drug for GI bleed - 50 - 100 ug IV bolus - 25 - 50 ug/hr IV Neurogenic shock - ANSWER-- CVP, CO, CO, PCWP, SVR: all DOWN - distributive - bradycardia/ hypotension -spinal cord injuries above T6 Arterial Line - ANSWER--Radial, femoral - Monitor pressures, blood draws, ABG's - Maintain pressure bag at 300 mmHg - Underdampening: air in the system, loose connection, decreased pressure bag, altitude changes - Overdampening: kinking, increased bag pressure, tip against wall Most common re-perfusion dysrhythmia - ANSWER-- AIVR (accelerated idioventricular rhythm) - expected after heart cath Hypokalemia on ECG - ANSWER-- PEAKED P's - flat T's Hyperkalemia on ECG - ANSWER-- Flat P's - Peaked T's - treat with calcium MAP goal with closed head injury - ANSWER-80-110 Cardiac Injury - ANSWER-- ST elevation - 1 mm in 2 leads Cardiac Ischemia - ANSWER-- ST depression - 1 mm in 2 leads Anterior MI - ANSWER-- V3, V4 - widow maker - LAD Posterior MI - ANSWER-- ST segment depression/ reciprocal changes - noted in V1-V4 - ST elevation V6 Septal MI - ANSWER-V1, V2 Inferior MI - ANSWER-- II, III, aVF RCA - Check R side - No nitro if R side MAP formula - ANSWER-(SBP + 2DBP)/3 Normal CPP heart - ANSWER-- 50-60 - DBP-wedge CPP goal with increased ICP - ANSWER-- 70-90 - MAP-ICP Normal ICP - ANSWER-0 - 10 mmHg GCS - ANSWER-Mild 13-15 Moderate 9-12 Severe 3-8 Calcium - ANSWER-8.5-10.5 mg/dL Chloride - ANSWER-95-105 mEq/L Potassium - ANSWER-3.5 - 5.5 elevated by metabolic acidosis Sodium - ANSWER-135-145 mEq/L Lateral MI - ANSWER-I, aVL, V5, V6 Cardiac Infarct - ANSWER-Q wave > 25% the height of the R wave Abdomen assessment order - ANSWER-Inspection Auscultation Palpation Percussion Contraindications for thrombolytics - ANSWER--Hx of hemorrhagic stroke -CVA last 12 months -SBP over 180 -Pregnancy/ 1 month post partum Normal pediatric BP - ANSWER-SBP: 90 + (2xage) DBP: 2/3 SBP -Drops after loss of 25% body fluid Killers of vent patients in flight - ANSWER-1. Pericardial Tamponade 2. Tension pneumothorax 3. Hypovolemia Death from crush injury is due to? - ANSWER-renal failure Complications of crush injury - ANSWER-DIC, Compartment Syndrome, Renal Failure, Hyperkalemia Cardiac output normal values - ANSWER-4-8 L/min SV x HR Cardiac Index - ANSWER-2.5-4 L/min/m2 Pulmonary artery systolic/ diastolic - ANSWER-15 - 25/ 8 - 15 Assess pressures at end of exhalation Chest tube insertion location - ANSWER-4th intercostal space 1-2 spaces higher in pregnant woman chest tube indications - ANSWER--pneumothorax -large pleural effusion -empyema -chylothorax -hemothorax needle thoracostomy location - ANSWER-- second intercostal space (below 2nd rib, above 3rd) midclavicular line - 5th ICS anterior mid-axillary line abruptio placentae - ANSWER-- Dark, red blood - Painful - Placenta detaches from womb - deprives baby O2 placenta previa - ANSWER-- blood is red and painless - part of placenta covers the opening in the mother's cervix Terbutaline - ANSWER-dose: 0.25 SQ - used for premature labor to stop - 22-37 weeks post partum hemorrhage - ANSWER-Bleeding in excess of 500cc after delivery. FUNDAL MASSAGE and put infant to breast. Place pad over vaginal opening and treat for shock, elevate hips. - Pitocin 10 iu IM, 20 iu in 1 L NS - Carbuprost tromethamine 0.25 IM up to 4x Q15 Uterine rupture - ANSWER-Fetal parts can be palpated over abdomen Cardiogenic shock - ANSWER-- CVP, PAS/PAD, PCWP, SVR: up - CO, CI: down - heart cannot pump enough blood and O2 to the brain and vital organs