Critical Care Transport/Flight Paramedic Exam With Complete Solutions

Critical Care Transport/Flight Paramedic Exam With Complete Solutions Sickled cells - answerRed blood cells that are less deformable and do not pass through microcirculation as easily, cause an increase in blood viscosity, and are sequestered and destroyed by the liver and spleen Acute chest syndrome - answerCondition that accounts for 25% of premature deaths in patients with sickle cell disease; the leading cause of hospitalization and death of sickle cell patients; symptoms include fever, cough, chest pain, dyspnea, new infiltrates on chest x-ray; no definitive therapy, only supportive care Integrilin, ReoPro, and Aggrastat - answerThe three glycoprotein IIb/IIa inhibitors that bind to a platelet receptor glycoprotein and inhibit platelet aggregation 760 mmHg/1 atm - answerBarometric pressure at sea level Physiologic zone - answerAtmospheric zone; sea level-10,000 ft; human body is well adapted; adequate pressure to allow for oxygen exchange, impairments are frequently due to changes in pressure (ascent or descent) Physiologically deficient zone - answerAtmospheric zone; 10,000-50,000 ft; noticeable deficits to humans; reduced barometric pressure results in poor oxygen exchange; most noticeable impairment is hypoxia (trapped gases can also cause hypoxia) Space equivalent zone - answerAtmospheric zone; 50,000-250,000 ft; environment incompatible with human life; pressurized suits and sealed cabins required; impairments include hypoxia, trapped gas, and emboli Boyle's Law - answerGas law; When temperature remains constant, the volume of a gas is inversely proportional to its pressure; As a gas bubble ascends, it expands. As it descends, it gets smaller; P1(V1) = P2(V2) Charles' Law - answerGas law; At a constant pressure, the volume of gas is directly proportional to its temperature; For every 1,000 ft (333 meters) of altitude increase, temperature decreases 2 degrees Celsius; V1/T1 = V2/T2 Ideal Gas Law - answerGas law; created to explain Boyle's Law vs. Charles Law; It takes a large amount of temperature change to affect a small amount of volume; pV = nRT (absolute pressure of gas x volume = amount of substance x gas constant x absolute temperature) Dalton's Law - answerGas law; The total pressure of a gas mixture is the sum of the individual partial pressure of all the gas in the mixture; As altitude increases, the amount of oxygen molecules decreases, but the percentage of molecules remains the same; Pt = P1 + P2 + P3... (Pt = total pressure of a gas) Henry's Law - answerGas law; The amount of gas in a solution is proportional to the partial pressure of gas in contact with the liquid; decompression sickness: increased nitrogen absorbed into the blood at depth, nitrogen "bubbles" exit the blood with rapid change in air pressure; soda bottle: CO2 held in suspension by pressure, lid is removed and CO2 exits to equalize with atmospheric pressure; P = KHC Graham's Law - answerGas law; With temperature and pressure held constant, the relative rate of diffusion of a gas is inversely proportional to the square roots of the density of those gases; The less dense the gas, the more rapidly the gas will diffuse through the air; Lighter gases diffuse more rapidly in narrowed peripheral airways (heliox); CO2 has a solubility factor 19 times greater than O2 and will more rapidly diffuse across a membrane 15 PSI/1 atm - answerAmount of pressure at 33 ft of ocean depth indifferent stage - answerfirst of the four stages of hypoxia; sea level to 10,000 ft in altitude; 33,000-39,000 ft if breathing 100% oxygen; SpO2 of 90-95%; night vision lost 5,000 ft; slight increase in heart rate and respiratory rate compensatory stage - answersecond of the four stages of hypoxia; 10,000-15,000 ft in altitude; 39,000-42,000 ft if breathing 100% oxygen; SpO2 80-90%; signs and symptoms include deceased alertness, subtle errors in judgement, fatigue, irritability, headache, tachycardia, tachypnea, increased blood pressure, increased tidal volume, altered mental status disturbance stage - answerthird of the four stages of hypoxia, 15,000-20,000 ft in altitude; 42,000-45,200 ft if breathing 100% oxygen; SpO2 70-80%; signs and symptoms include fatigue, dizziness, cyanosis, impairment, tachypnea, altered mental status, impaired central and peripheral vision, and personality changes; period of useful consciousness is 15-20 minutes critical stage - answerlast of the four stages of hypoxia; 20,000-23,000 ft in altitude, 45,200- 46,800 ft if breathing 100% oxygen; SpO2 60-70%; signs and symptoms include severe altered mental status, seizures, impairment, unconsciousness, severe mental and physical capacitation, and death hypoxic hypoxia - answerone of the four types of hypoxia; inadequate oxygenation secondary to reduced partial pressures of oxygen in inspired air; caused by reduced PaO2, impaired gas exchange across the alveolar-capillary membrane, or impaired ventilation anemic (hypemic) hypoxia - answerone of the four types of hypoxia; inadequate tissue oxygenation secondary to reduced to reduced oxygen-carrying capacity (from either inadequate availability of oxygen molecules or obstructive pathology that prevents oxygen from diffusing across alveolar membranes); caused by CO poisoning, anemia, blood loss, drugs causing methemoglobinemia, alcohol use or abuse, COPD, pneumonia, pulmonary edema, or pulmonary embolism stagnant hypoxia - answerone of the four types of hypoxia; inadequate tissue oxygenation secondary to reduced cardiac output, pooling of blood, reduced blood flow to tissues, or restriction of blood flow; cause by heart failure, shock, gravitational forces, positive pressure ventilation, or pulmonary embolism histotoxic hypoxia - answerone of the four types of hypoxia; inadequate tissue oxygenation secondary to metabolic disorder or poisoning of the cytochrome oxidase enzyme system resulting in cellular inability to utilize oxygen; caused by toxic gas poisoning, alcohol or narcotic abuse, or cyanide poisoning temperature - answerthe "vital sign" should be monitored on ALL patients during flight, especially pediatric patients 30 degrees - answerangle at which the patient's head should be raised on the stretcher in most cases, especially intubated patients and patients with head injuries rotor-wing aircraft - answertype of aircraft typically used for transports less than 150 nautical miles; operates at sustained speeds of 100-200 mph and at altitudes less than 10,000 ft fixed-wing aircraft - answertype of aircraft typically used for transports over 150 nautical miles; operates at speed ranges from 300-600 mph and at altitudes up to 38,000 ft Part 91 - answerthe section of Title 14 of the Code of Federal Regulations that governs the operation of all aircraft within the U.S., including the waters within 12 nautical miles of the U.S. coast; can only be used when NO medical crew is on board Part 135 - answerthe section of Title 14 of the Code of Federal Regulations that governs all commuter or on-demand commercial flight operations; contains strict weather minimums and duty times; requires that pilots have no more than 14 hours of duty time followed by at least 10 hours of rest; must be used when a medical crew is on board Crew Resource Management (CRM) - answerone solution that has been implemented to reduce the number of air medical accidents defined as using all available resources