Advanced Medical Life Support with
complete solutions
the six Rs to put together information and make better judgments under pressure - correct answer
✔✔Read the scene
- observe environmental conditions
read the patient
- assess the pat. condition, vital signs, treat life threats, review chief complaint
react
+ manage life threats, ABC, in order discovered, treat pat. based on cardinal presentation
reevaluate
- reassess
revise management plan
- revise management plan to new clinical picture
review performance
- critiquing the call or pat. encounter for reflection
algorithm for AMLS patient assessment - correct answer ✔✔
normal PaCO2 levels - correct answer ✔✔35-45 mmHg (or 5,1-5,6 kPa)
normal PaO2 levels - correct answer ✔✔80-100 mmHg (10-13,5 kPa)
,normal adult male TLC - correct answer ✔✔6000 ml
lung volumes approx:
- IRV
- RV
- ERV
- TV - correct answer ✔✔- 3000
- 1200
- 1200
- 500
minute volume formula - correct answer ✔✔RR x TV - dead space
tactile (vocal) fremitus:
conditions in which it may be increased
conditions in which it may be decreased - correct answer ✔✔- pneumonia
- Ptx, pleural effusion
,how can we ddx respiratory distress from respiratory failure - correct answer ✔✔if pat. improves with
simple resuscitation maneuveres -> respiratory distress
if not -> respiratory failure
normal ETCO2 levels - correct answer ✔✔35-45 mmHg
ABG, BE values, normal range and meaning - correct answer ✔✔normal: -3 to +3
- Ω acidosis
+ Ω alkalosis
ABG, normal HCO3- range - correct answer ✔✔22-26
adjusting postiive-pressure ventilation, how to adjust if:
- increased PaCO2
- decreased Paco2
- how to adjust FiO2 - correct answer ✔✔- increase f x2-5 or VT x 50-100 ml (f is rate)
- decrease fx2-5 or VT x 50-100 ml
- for increases of SpO2 > 95% decrease FiO2 in increments of 5% to maintain SpO2 > 94%
respiratory disorders, examples of initial and basic management techniques - correct answer ✔✔O2
- nasal cannula
, - Venturi, standard face mask
- reservoir
positive-pressure ventilation
- bag-mask device
- CPAP
- BiPAP
invasive airway ventilation
- pressure-cycled ventilation
- volume-cycled ventilation
ABG criteria for acute respiratory failure - correct answer ✔✔PaO2 < 55 mmHg
PaCO2 > 50 mmHg
pH < 7,32
modes of ventilatory support, 4 principal methods - correct answer ✔✔controlled mechanical
ventilation (CMV)
- ventilator deliver breath at preset interval, regardless of patients effort
- for apneic pat. and pharm. paralysis
assist/controlled ventilation (A/C)
- if pat. takes breath, assisted breath is given at the same time, and ventilator monitor resets within 5 sec
- if no breath within 5 sec -> machine delivers and clock starts again
intermittent mandatory ventilation (IMV)
- CMV combined with pat. spontaneous ventilation
complete solutions
the six Rs to put together information and make better judgments under pressure - correct answer
✔✔Read the scene
- observe environmental conditions
read the patient
- assess the pat. condition, vital signs, treat life threats, review chief complaint
react
+ manage life threats, ABC, in order discovered, treat pat. based on cardinal presentation
reevaluate
- reassess
revise management plan
- revise management plan to new clinical picture
review performance
- critiquing the call or pat. encounter for reflection
algorithm for AMLS patient assessment - correct answer ✔✔
normal PaCO2 levels - correct answer ✔✔35-45 mmHg (or 5,1-5,6 kPa)
normal PaO2 levels - correct answer ✔✔80-100 mmHg (10-13,5 kPa)
,normal adult male TLC - correct answer ✔✔6000 ml
lung volumes approx:
- IRV
- RV
- ERV
- TV - correct answer ✔✔- 3000
- 1200
- 1200
- 500
minute volume formula - correct answer ✔✔RR x TV - dead space
tactile (vocal) fremitus:
conditions in which it may be increased
conditions in which it may be decreased - correct answer ✔✔- pneumonia
- Ptx, pleural effusion
,how can we ddx respiratory distress from respiratory failure - correct answer ✔✔if pat. improves with
simple resuscitation maneuveres -> respiratory distress
if not -> respiratory failure
normal ETCO2 levels - correct answer ✔✔35-45 mmHg
ABG, BE values, normal range and meaning - correct answer ✔✔normal: -3 to +3
- Ω acidosis
+ Ω alkalosis
ABG, normal HCO3- range - correct answer ✔✔22-26
adjusting postiive-pressure ventilation, how to adjust if:
- increased PaCO2
- decreased Paco2
- how to adjust FiO2 - correct answer ✔✔- increase f x2-5 or VT x 50-100 ml (f is rate)
- decrease fx2-5 or VT x 50-100 ml
- for increases of SpO2 > 95% decrease FiO2 in increments of 5% to maintain SpO2 > 94%
respiratory disorders, examples of initial and basic management techniques - correct answer ✔✔O2
- nasal cannula
, - Venturi, standard face mask
- reservoir
positive-pressure ventilation
- bag-mask device
- CPAP
- BiPAP
invasive airway ventilation
- pressure-cycled ventilation
- volume-cycled ventilation
ABG criteria for acute respiratory failure - correct answer ✔✔PaO2 < 55 mmHg
PaCO2 > 50 mmHg
pH < 7,32
modes of ventilatory support, 4 principal methods - correct answer ✔✔controlled mechanical
ventilation (CMV)
- ventilator deliver breath at preset interval, regardless of patients effort
- for apneic pat. and pharm. paralysis
assist/controlled ventilation (A/C)
- if pat. takes breath, assisted breath is given at the same time, and ventilator monitor resets within 5 sec
- if no breath within 5 sec -> machine delivers and clock starts again
intermittent mandatory ventilation (IMV)
- CMV combined with pat. spontaneous ventilation
