Critical Care Paramedic Exam

Critical Care Paramedic Exam Normal pH 7.35-7.45 Normal CO2 35-45 Normal HCO3 22-26 (good dating age) Normal PaO2 80-100 Normal SaO2 95% Base (deficit/excess) (-2) - (+2) Buffer systems: Bicarb reaction time seconds Buffer systems: Lungs reaction time minutes Buffer systems: Kidneys reaction time hours to days Minute volume calculation Tidal volume x respiratory rate pCO2 45 acidotic pCO2 35 alkalotic HCO3 22 acidotic HCO3 26 alkalotic base deficit of -4 indicator for the potential need for blood transfusion base deficit of -19 indicates poor outcome (death likely) base deficit replacement formula 0.1 x (-BE) x patient weight in kg = bicarb needed PO2 of 60 is roughly equivalent to a SaO2 of 90% critical pH for intubation 7.2 critical pCO2 for intubation 55 critical pO2 for intubation 60 number one cause of metabolic acidosis lactic acidosis (lactate 4) CO2 is a byproduct of metabolism for every __ change in ETCO2, you should expect the pH to change __ in the ___________ direction. 10, 0.08, opposite for every __ change in pH, you should expect the HCO3 to change __ in the ___________ direction. 0.15, 10, same for every __ change in pH, you should expect the potassium to change __ in the ___________ direction. 0.10, 0.6, opposite LEMON difficult intubation look, evaluate (3-3-2), mallampati, obstructions, neck mobility HEAVEN difficult intubation Hypoxia, extremes of size, anatomic challenges, vomit/blood/fluid, exsanguination, neck mobility issues ramping ear to sternal notch without ramping during intubation or transport causes a potential for decrease in functional reserve capacity, tidal volume, and preload Sellick's maneuver and BURP no longer recommended External laryngeal manipulation (ELM) current standard of practice bougie adult size 15 Fr bougie pediatric size 10 Fr bougie neonatal size 6 Fr supraglottic devices provide little protection against aspiration ETT cuff pressure 20-30 mmHg (25 is standard) gold standard of confirming ET placement chest X-Ray distal tip of ET 2-3 cm (1 inch) above carina, at T3 or T4 7 p's for RSI success preparation, preoxygenation, pretreatment, paralysis with induction, protect/position, placement (with proof), post intubation management LOAD pretreatment for RSI lidocaine, opiates, atropine (infants), defasiculating dose fentanyl adult dose 1 mcg/kg fentanyl onset 3-5 mins fentanyl post intubation management 0.5 - 1.5 mcg/kg every 5 minutes fentanyl post intubation management infusion 1-3 mcg/kg/hour fentanyl reversal agent narcan etomidate adult dose 0.3 mg/kg etomidate onset time 15-45 seconds etomidate duration 3-12 minutes etomidate cautions/contraindications hemodynamically unstable patients, adrenal suppression, shock patients, COPD/asthmatic ketamine adult dose 1-2 mg/kg ketamine onset 40-60 seconds ketamine duration 10-20 minutes ketamine is preferred for asthmatic patients ketamine post intubation management 0.5 - 1 mg/kg