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 (Propanolol), 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 membrane potential] Chloride (Cl-) Extracellular Anion 95-105 mEq/L [Maintains osmotic pressure, and helps the stomach produce HCl or Hydrochloric Acid] Carbon Dioxide (CO2 gas) 22-26 mEq/L [Acid Base Balance contributor] BUN Blood Urea Nitrogen 6-24 mg/dL Indicates ability of Renal Clearance Cr Creatinine 0.7 -1.4 mg/dL Renal Clearance Glucose (Blood Glucose Level) 80-120 mg/dL Burns (pg. 126) - ANS 1st Degree - Sunburns 2nd Degree - Blisters "Partial Thickness" 3rd Degree - Completely Destroyed Tissue "Full Thickness) Burn Formulas (pg. 126) - ANS Brooke - 2cc x kg x BSA = fluids over 24hrs (1st half in 1st 8 hrs from time of burn) Universal "Consensus Formula" - 2-4cc x kg x BSA = fluids over 24hrs (1st half in 1st 8hrs from time of burn) Parkland - 4cc x kg x BSA = fluids over 24hrs (1st half in 1st 8hr from time of burn) Only for 2nd and 3rd degree burn types. What is the preferred burn formula? (pg. 126) - ANS Parkland Formula is the preferred burn formula. Lactated Ringers is the preferred fluid administered. BSA Burn % Child (pg. 126) - ANS Head and Neck - 18% Each Arm - 9% (Both Arms 18%) Each Leg - 14% (Both Arms 28%) Anterior Trunk - 18% Posterior Trunk - 18% Palmer Method: The palm represents 1% BSA in both Adults and Children. BSA Burn % Adult (pg. 126) - ANS Head - 9% (Face 4.5%) Neck - 1% Each Arm - 9% (Both Arms 18%) Each Leg - 18% (Both Arms 36%) Anterior Trunk - 18% Posterior Trunk - 18% Palmer Method: The palm represents 1% BSA in both Adults and Children. Average Urine Output: 30-50 mL/hr for Adults Burns 20% (pg. 126) - ANS Possibility for Adynamic Ileus (Decreased Bowel Movement) Causes problems in-flight due to the expansion of wet gasses is restricted (Boyle's Law) Newton's 1st Law of Motion (pg. 130) - ANS Law of Inertia Unless it is acted upon by a force, a body at rest will remain at rest and a body in motion will move at constant speed in a straight line. Newton's 2nd Law of Motion (pg. 130) - ANS Force = Mass x Acceleration (F = M x A) When a force is applied to a body, the body accelerates, and the acceleration is directly proportional to the force applied and inversely proportional to the mass of the body.