Critical Care Paramedic Exam Questions and Answers

Critical Care Paramedic Exam Questions and Answers Laryngoscopy - Answer-Step1-Appropriate Sniffing Position: head back, neck flexed (ear hole/external auditory eatus is at same plane as sternal notch. Need to elevate head 5-7inches up (once elevated, tilt head all the way back). Step2-translate mandibular process by opening mouth, two finger technique Step3-Insert scope, inch down tongue until you see epiglottis Step4-Make Vallecula actual space with ELM, and with no force yet, put blade under vallecula Step5-Lift until see posterior notch, or until head moves up CVA HTN Tx if over Sys: 210 or Dia: 120 - Answer-Start with Nicardipine, 5mg/hr and titrate up with adding 2.5mg/hr every 5 minsnprior to dropping back down, up to 15mg Bougie Cricothyrotomy - Answer-Step1-Equipment (6cuffed, syringe,scalpel, bvm w/Etco2, dressing, bougie) Step2-Landmarks (between cricoid ring and thyroid cartilage)-can't find, then vertical incision Step3-1.5-2cm incision into cricothyroid membrane, immediately placing finger into incision to augment/keep location. Step4-insert bougie, feel for tracheal clicks Step5-insert 6 ETT, make have to put pressure/back&forth, and once balloon in, your good to blow up cuff hypotension with ACS - Answer-Consider 1-2L NS, and then inotropes: dopamine/dobutamine For AMS and hx Alcoholism/Malnutrition - Answer-Give Thiamine IV 100mg Options for Combative Patient - Answer-1)Versed 2-5mg IV 2)Ativan 1-2mg IV, q/3mins can repeat 3)Valium 5-10mg can repeat 15min 4)Haldol same as Valium but IM also 5)Ketamine .2mg/kg For adult anaphylaxis don't forget - Answer-corticosteroid: Solumedrol, helps with late phase 200mg Anaphylaxis, 125mg Hace and Resp. Distress History of WPW, treat like - Answer-V-Tach Protocol, not Afib-RVR so Ami 150mg in ten mins, may repeat Afib RVR Stable vs. Unstable - Answer-Dilt IV 5-10 mins =Stable (can repeat in 5-10) .25mg/kg (repeat at .35) Cardiovert 100J=Unstable don't forget 12 leads Positioning for CVA pts - Answer-20-30 degree head elevation Cincinnati Stroke Scale - Answer-Droop, Drift, Speech On CVAs don't forget? - Answer-12-lead, over 185/110 & candidate, over 185 2x give 10mg labetalol, titrate to effect but don't drop more than 15% Blood Glucose should not be dropped? - Answer-50-100 mg/dl per hour In DKA patients, avoid? - Answer-intubation, if you have to, set RR @30, help breath off acid Sepsis Patient Induction - Answer-Use Ketamine over Etomidate due to adrenal suppression, Fun Facts of Sepsis - Answer-1-raise HOB 30-45 degrees 2-CVPs goal=8-12mmHg 3-MAP goal= greater than 65 4-fluid challenges, 3l crystalloid over 45 mins Levels of hyperkalemia - Answer-1-Tall peaked T waves (6mEq/l) 2-Prolonged PR interval (6.5mEq/l) 3-Loss of p-wave (6.5-7) 4-Widening of qrs (7-7.5) 5-Sine wave, v-fib/tach (8-10) Hyperkalemia Treatment - Answer-1-CaCl 500mg IV over 3 mins (EKG changes or K+ greater than 6.2), 2-NaHCO3 50meq/or 1meEq/kg over 5 mins (especially if acidotic) 3-Albuterol 5-20mg over 15 mins 4-Glucose/Insulin: 10 units reg. insulin IV push, and 25 grams D50W IV push (just give the 10U of insulin is BS more than 200) Significant Sepsis Prognostic - Answer-Lactate greater than 4, ticking time bombs GI Hemorrhage - Answer--NG/OG -Octreotide: decreases GI Motility/Acid Prod., decreases hepatic portal pressures, relieves venous congestion, 25-50mcg IV Push, and then 25-50 mcg/hr IV