Critical Care Paramedic (Kyle Faudree's Flight Paramedic Certification) Study Guide

Critical Care Paramedic (Kyle Faudree's Flight Paramedic Certification) Study Guide Hyperthyroidism/Grave's Disease/Thyrotoxicosis/"Thyroid Storm" (pg.111) - ANS Patient presents with weight loss, palpitations, nervousness, heat intolerance Exophthalmos (AKA proptosis) 'bulging of the eye' AVOID Aspirin (ASA) - Prevents binding of thyroglobulin, making the situation worse Treatment: IV Fluids 1st, Beta Blockers (Propranolol), Steroids (Dexamethasone), and Tylenol for fever. Septic Shock (pg.113) - ANS Someone who is in shock second degree to sepsis (infection in the bloodstream) Hypotensive with normal HR Hypotensive while being refractory to fluids Patient needs IV fluid therapy and vasopressors Levophed (Norepinephrine) is vasopressor of choice in profound hypotension Do not use Etomidate in RSI (due to its adrenal suppression) *Also do not use Etomidate in Addison's Disease also due to the adrenal suppression Pancreatitis (pg.113) - ANS Pain that is usually centered in the upper middle or upper left abdomen. Often radiates from the front of the abdomen through to the back, begins or worsens after eating, lasts a few days, and may feel worse when a person lies flat on their back. The digestive enzymes in the pancreas are destroying the pancreas. Increased lipase levels (usually >3x normal) *Amylase may also be increased but Faudree did not preface this in his study guide notes. Demerol for pain (b/c Morphine has the ability to cause spasms of the Sphincter of Oddi) Typically requires surgical intervention. Grey Turner's Sign (pg.113) - ANS Flank ecchymosis caused by hemorrhagic pancreatitis. Cullen's Sign (pg. 113) - ANS Periumbilical ecchymosis caused by hemorrhagic pancreatitis. Hypothyroidism/Myxedema Coma (pg. 112) - ANS Patient presents with fatigue, cold intolerance, weight gain, puffy eyelids, sparse hair, possibly goiter. Primarily occurs in women. >90% cases in winter (b/c the patient has cold intolerance and is not suffering from hypothermia) Officially Myxedema Coma upon changes in LOC. Treatment: Levothyroxine (Synthroid) (T4) or Triostat (T3) IV Cushing's Syndrome (pg.112) - ANS Buffalo hump, moon face, thin arms and legs, purple striae on abdomen. Causes: Excessive use of corticosteroids (Iatrogenic, from corticosteroid treatment(s)) or Tumor Treatment: Usually resolves when corticosteroids are stopped or tumor is removed. Adrenal Insufficiency/Adrenal Crisis (pg. 112) - ANS Also known as (AKA): Addison's Disease Patient presents with depression, malaise, salt craving, and bronze colored skin like JFK. Treatment: Oral steroids (Prednisone) Negative Adrenocorticotropic hormone (ACTH) testing, also known as corticotropin or cosyntropin test. No Etomidate in RSI due to adrenal suppression. Laboratory Values Basic Metabolic Panel (BMP or CHEM7) (pg.106) - ANS Sodium (Na+) Primary Extracellular Cation: 135-145 mEq/L [Helps nerves and muscles interact] Potassium (K+) Primary Intracellular Cation: 3.5-5.0 mEq/L MOST DANGEROUS ABNORMALITY [Responsible for cell excitability, resting me