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195 Cards in this Set
- Front
- Back
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What is this goal of the CCEMT-P
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continuous bed to bed care.
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reason most law suits occur in critical care
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airways
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negligence
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failure to use such care as a reasonable and prudent practitioner would under similar circumstances
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assault vs battery
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assault is verbal battery is physical touch
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EMTALA is under which act
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social Security act of 1986.
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What is involuntary consent:
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a 302 patient, could be an inmate, or a minor
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specificity
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probability that a test will be negative in absence of disease
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sensitivity:
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probability that a test will be positive in presence of disease
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primary acid excreting organs
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lungs(co2) and kidneys (hco3)
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carbonic buffer system
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effective, but slow correcting of acid base.
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respiratory acidosis causes:
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-CNS depression
-neuromuscular disease -Trauma: HIGH SPINAL CORD INJURY. -obstructive disease: obesity or lung diseases. |
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respiratory alkalosis causes
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anxiety
head trauma fever pain PE altitude asthma |
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form of metabolism that builds lactic acid
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anaerobic metabolism often due to metabolic acidosis.
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most common cause of normal metabolic acidosis anion gap
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Diarrhea
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What causes dilutional acidosis
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excessive fluid admin without electrolyte replacement
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pH, PaCO2, HCO3, BE, PaO2, SaO2 normal values:
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pH: 7.35-7.45
HCO3: 22-26 BE: -2+2 PaO2: 80-100 SaO2: 90-100% (>95) |
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ABG golden rules:
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-every 10mmHg change in CO2 results in pH of .08 in opposite direction.
-every 10mmHg change in HCO3 will cause .15 change of pH in same direction |
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bicarb replacement formula
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kg/4× base deficit
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CBC (complete blood count) consists of
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white blood count
WBC differential RBC count H&H platelet count |
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elevated WBC count causes:
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infection
leukemia liver cirrhosis burns tissue necrosis |
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causes of low WBC
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hematopoietic disease
malaria bone marrow suppresion anemia viral infection stress trauma fever |
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Red blood cell used for
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oxygen transport: normal value 5
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if respirations increase which way will the pH go?
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pH will also increase (alkalosis)
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if respirations decrease which direction will the H+ go?
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H+ will increase (acidosis)
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What does hematocrit measure?
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it measure the number of red blood cells in 100ml of blood. expressed in %. normal is 45%.
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What is PT and what does it measure
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prothrombin time: measures effectiveness of Coumadin type anticoagulants. normal is 11.2 -13.2 seconds
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INR normals
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-international normalized ratio: AKA PT- INR: in normal person not on anticoagulants it should be 1.
-typical numbers of person taking anticoagulants is 1.5-2.5 |
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BUN
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measures metabolic breakdown of blood, muscle, and proteins.
7-21 is normal value. causes for increased levels would include a GI bleed or disease causing breakdown of blood, muscles, proteins. |
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elevates sodium causes:
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dehydration
excessive sodium intake Diabetes insipidus coma CHF Cushing disease |
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low sodium causes
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vomiting/diarrhea
GI suction over hydrated DKA diuretic use renal disease Addison disease burns |
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creatinine normal values:
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creatinine is a waste product of protein metabolism.
normal value is 06-1.4 |
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What is renal failure and lab values associated with:
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renal failure occurs with rapid decline in renal filtration function.
creatinine is typically elevated as well as the BUN. BUN/Creatinine ration of >10:1 indicates renal failure |
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diuretics typically cause what metabolic disturbance?
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metabolic alkalosis
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What is the most SPECIFIC lab value for an AMI?
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troponin.
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normal Ca++, K+, Na+
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sodium 135-145
potassium 3.5-5 calcium 9-11 |
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BNP value that indicates probable heart failure
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>400pg/ml
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What does lactate indicate??
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indicates anaerobic metabolism.
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What is a fistula and how is it formed?
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fistula are formed by surgically connecting the walls of an artery to a vein and usually take 3-6 months to mature.
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CVAC tunneled cath # lumens, short or long term use?
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can be single, double, or multi lumen and are typically for home use and long term use.
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SVAD aka port a cath require what needle? if not available what is an alternative?
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a Huber needle is to be used.
if unknown Huber size or NA, use a 22g 1.5in |
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sluggish infusion of cvac management
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-reposition
-remove injection cap and inspect for a clot -flush vigorously with 20-30ml of NSS |
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arterial line indication, prefered site, and labeling:
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-it is indicated for beat to beat blood pressure management.
-should be labeled red to prevent ANY medications from being administered through the line. -radial artery is prefered site. |
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equipment needed for arterial cath
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-special tubing that is rigid
-500cc bag with 300mmHg pressure bag. -Transducer -amplifier -monitor |
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dampening of arterial waveform in reguard to BP and causes of?
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-dampening usually underestimates blood pressure.
-causes include: blood clot, tube kinking, compression of air bubbles, drag of saline in the line. |
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trouble shooting lost arterial waveform:
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check for kinks
clots in tube all cables connected? try new transducer ENSURE IT IS STILL IN PLACE |
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purpose of hemodynamic monitoring:
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most important aspect is the determination of CARDIAC OUTPUT!
evaluates blood flow to tissues |
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goals of monitoring hemodynamics
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determine left ventricular preload
assess peripheral perfusion determine left ventricular function |
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4 lumens of the pulmonary artery catheter:
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-Distal lumen is yellow measures the pressures in the pulmonary artery.
-balloon inflation port is red and is inflated to advance catheter during insertion and to wedge the catheter when it's in the pulmonary artery -proximal lumen is blue and is located in the right atrium. used to measure CVP (preload) which is normally 2-6 (same as right ventricle pressure (RVP) - infusion port is white and is used for medication infusions as well as to check temperature. -intracardiac pacing lumen has opening in right atrium or ventricle and does atrial or ventricular pacing. |
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What does CVP measure?
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CVP (central venous pressure) measures the right end diastolic pressure (preload) normal value is 2-6mmHg.
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common site for Arterial catheter
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subclavian vein
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leveling the transducer in PAC:
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-3way stopcock is closed to patient and open to air
-press zero button for 3 seconds and zeroes should be displayed. -close the stopcock so that it is open to patient. -readings should appear on monitor immediately. |
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Where should transducer be placed at:
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should be at the level of the right atrium. AKA phlebostatic axis.
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if placed lower than phlebostatic axis what readings would you get? what if higher than axis?
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if it is placed higher then you wpuld get a lower reading.
if it is lower than you would see a higher reading. |
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causes of elevated CVP
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Right side heart failure
cardiac tamponade pulmonary HTN volume overload positive pressure ventilations |
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causes of low CVP:
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volume depletion
vasodilation venous vasodilation |
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RVP values and when readings are taken
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RVP measures the pressure in the right ventricle while inserting the pulmonary cath.
systolic pressures are 15-30 diastolic are 0-8 |
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PAP normal values
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is the pressure in the pulmonary artery when the balloon is DEFLATED.
(left ventricle or afterload) systolic pressure is 15-30 diastolic pressure is 8-15 |
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What size syringe to inflate iabp, time it may be inflated, normal values:
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a 1.5cc is used to inflate the Balloon which should be inflated for no more than 15 seconds.
normal values are 4-12mmHg |
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Where is the IABP placed:
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1-2cm below the left subclavian and above renal.
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What is cardiac output and the normal values:
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cardiac output is the amount of blood ejected by left ventricle each minute.
normal cardiac output is 4-8lpm. |
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What would increase cardiac output:
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-sympathetic nervous system stimulation
-positive inotropic stimulation -hyperthyroidism -hypervolemia -anemia -catecholamine admin -RISE IN CO increases oxygen demand. |
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When is cardiac output decreased:
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-heart rate greater than 150
-decreased heart rate -decreased contractility -increased afterload. |
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normal cardiac index and how to calculate it:
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normal cardiac index is 2.5-4.2 and is calculated by cardiac output ÷ BSA.
a cardiac index >1.8 indicates cardiogenic shock |
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if you find rust colored flakes in the tube of IABP what would you suspect?
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blood in the tube from rupturing.
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causes of a sypply/demand mismatch
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-decreased CO leads to decreased oxygen supply to tissue
-decreased oxygen availability leads to less oxygen supply to tissue. -decreased hemoglobin availability -inability for oxygen to leave hemoglobin. |
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normal LVA
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it is the systemic vascular resistance.
8-1200 dynes/sec/cm2 |
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treatment of a forward Displaced IABP:
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-try turning patient on their side.
-if this fails call a physician immediately for guidance, as the catheter will need to be pulled back 3-4cm. |
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backward displacement treatment
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notify MD immediately and ensure balloon is deflated. pull cath back into right atrium to avoid lethal dysrhythmias and possible catheter whipping.
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iabp dampened waveform causes
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air/blood in tubing
blood in transducer low fluid lvl in flush bag catheter kinked catheter migrated forward spontaneous wedge |
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dampened waveform treatment:
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-attempt to pull back into right atrium if it migrated forward.
-if waveform indicates spontaneous wedge and the balloon is deflated, be prepared to pull catheter back into pulmonary artery. |
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if no waveform is observed while iabp is inserted:
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-stopcock turned off to patient
-catheter tip is clotted -monitor/system is setup wrong -equipment not working |
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plasma made up mostly of:
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90% of plasma is made up of water.
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What portion of blood contains antigens and which antigen is it typically?
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Rh antigens are actually the "D" antigen which are found in red blood cells.
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risks of Rh+ in an Rh- person
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once a person who is Rh- is given Rh+ blood, the person will have antigens which will cause an alergic reaction if they receive it again.
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blood typing:
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process of classifying individuals based on their antigens on erythrocytes.
AKA ABO blood group. |
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What is the universal donor blood?
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O- is the universal donor blood.
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What is the universal blood recipient?
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AB+ and Rh+ person.
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What blood product is given to treat thrombocytopenia?
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platelets are used to treat thrombocytopenia and you do not need to do blood typing.
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When is whole blood given?
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typically whole blood is only given in people with hemorrhagic shock, or severally anemic patients.
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Why do patients receiving large units of blood need monitored for hypocalcemia?
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citric acid is in the packaged blood which binds calcium.
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FFP composition
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plasma
ALL coagulation factors NO platelets |
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When is FFP indicated and what is it compatibility?
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indicated for patient who is actively bleeding or has documented coagulation factor deficiency.
patient must be ABO compatible! |
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What is given to treat hemophilia
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cryoprecipitate is given for hemophilia A
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most subtle indications of a transfusion reaction:
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increased heart rate and temp.
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What is TRALI
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transfusion related acute Lung injury. it is unpredictable and unpreventable.
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hyperkalemia in person receiving blood
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hemolysis of stored blood occurs causing an increase in potassium.
the longer the blood is stored, the higher the potassium level is in the blood. |
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What is 2,3-DPG?
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it is the "crowbar" that forces oxygen off of the hemoglobin.
if person is in a left shift they will have decreased ability to offload oxygen. |
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causes of right shift in hemoglobin curve
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increase PCO2
increase temp increase 2,3-DPG decrease pH |
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causes of left shift in hemoglobin curve
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decreased PCO2
decrease temp decrease 2,3-DPG increase pH **carbon monoxide poisoning** |
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MOANS acronym in airway:
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Mask/seal
obesity/obstruction age No teeth stiff |
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What is seen on x ray with epiglotitis?
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thumb print sign
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What is the medication given for magnesium toxicity?
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calcium gluconate is given for magnesium OD
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stressor of flight
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hypoxia
barometric changes thermal variations fatigue noise vibration |
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4 types of hypoxia
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hypoxic
histoxic anemic stagnant |
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rotary wing used for what distance?
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less than 150 nautical miles
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size of LZ
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100x100
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air on radiograph
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black
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blood on radiograph
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white in acute bleeding, grey/black in old blood
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correct placement of distal end of thbe
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3-7cm above carina
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acute infections typically have a left or right shift?
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left shift is usually seen as an increase in number of neutrophil bands.
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CPK normal value and what it's used to measure
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creatine phosphokinase is normally 5-35mcg/ml and is used to evaluate renal function
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When injecting anything into a dialysis shunt what is the smallest syringe you should use
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10cc is smallest.
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is a PICC line a tunneled or non tunneled cath?
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non tunneled cath
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CVP and RAP measure?
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Right ventricle end diastolic pressure.
(preload) |
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PAWP reflects what pressure?
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LVEDP left ventricular end diastolic pressure
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patients receiving large amounts of blood should be monitored for what lab value?
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hypocalcemia due to citric acid
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FFP should be given within what time after thaw?
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within 6 hours of thawing
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clinical criteria for an ARDS patient:
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has an acute onset
PAWP <18 predisposing condition PaO2/Fio2 <200 reguardless of PEEP levels. |
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most common complaint in elderly ACS patients
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Dyspnea
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What would you find on an ekg with pericarditis or myocarditis?
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ST elevation is seen in almost all leads
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3 causes of airway obstruction in COPD
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broncho-constriction
airway edema mucus plugging |
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adrenergic agonists
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albuterol
terbutaline |
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anticholinergics
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ipratropium bromide
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most common cause of sudden unexpected arrest second to CAD
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pulmonary embolus
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persons at increased risk for PE
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AMI,CHF,A-fib
pregnancy postpartum oral contraceptives HYPERCOAGULABILITY |
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altered mental status in respiratory patient indicates
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severe hypoxia and impending respiratory arrest.
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most common symptom of PE
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dyspnea in 73%
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Gold standard test for PE
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CT scan
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common cardiac arrhythmia in PE
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sinus tachycardia
non specific ST changes |
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What is the usual catalyst of ARDS
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sepsis
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When does ARDS usually develop
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after a significant physiologic event.
THIS IS A SYSTEMATIC INFLAMMATION RESPONSE NOT INFECTIOUS PROCESS |
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clinical criteria for ARDS
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-acute onset
-predisposing factor -bilateral infiltrates on chest radiograph -PCWP <18mmHg |
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PaCO2 abnormalities in PE
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hypocapnia early
hypercapnia late |
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vent settings in the ARDS patient
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should mimic the origional settings.
start TV low and reduce the TV until PIP is under 35. if low inspiratory volume results, add PEEP |
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What causes a bypass in upper airway defenses
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ET tube
suction catheters NG tubes |
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pneumonia chest scan
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infiltrates
plural effusion consolidation |
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iatrogenic risk factors that may cause pneumothorax
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positive pressure ventilations
central venous catheter placement thoracentesis nasogastric tube placement bronchoscopy CPR |
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primary spontaneous pneumo results from
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subpleural emphysema blebs
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secondary spontaneous pneumo from
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COPD is most common associated disease
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signs and symptoms of tension pneumo
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decreasing SaO2
tachycardia resp distress increased inspiratory pressure hypotension PEA |
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What is heimlich valve
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one way valve that attahces to chest tube.
replaces the underwater pleural drainage system typically used in long standing pneumothorax kits. |
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patient positioning during tube thoracostomy
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30-60 degrees
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air removal site
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midclavicular 2nd space
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fluid removal site
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midaxillary 4th
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drainage unit FOCAL assessment
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Fluctuation
output color air leak levels |
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anaphylactoid
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reaction produces a similar response to an anaphylactic reaction but isn't immune mediated
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3 layers of heart
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epicardium is outer layer
myocardium is middle muscular layer endocardium is inner layer |
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left coronary artery
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-LCA
-circumflex supplies blood to left atrium and posterior left ventricle |
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Right artery
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supplies right atrium and branches to marginal and posterior artery
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Right artery supplies
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Right atrium
anterior right ventricle inferior left ventricle posterior ventricle 1/3 septum |
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left artery supplies
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left anterior descending:
anterior left ventricle 2/3 septum apex of left ventricle left circumflex left atrium posterior left ventricle |
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systole of cardiac cycle
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depolarization: sodium and calcium move into the cells
repolarization: Potassium flows out of cells |
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frank starlings law
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the degree of stretch in diastole determines velocity and force of contraction
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cardiac output is what
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the end measurement of hemodynamics
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mean arterial pressure
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(2x diastolic + systolic) ÷3
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3 major functions of renal system
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excretion
elimination regulation |
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goal of urine production
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maintain homeostasis by regulating volume and composition of blood
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GFR
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glomerular filtration rate: the amount of filtrate produced by the kidneys each minute
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bun about 60 indicates
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severe renal failure
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most common used diuretic
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thiazide inhibits sodium - chloride transport
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emergent dialysis AEIOU
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acidosis
electrolytes ingestion overload uremia rhabdomylysis |
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rhabdomylysis is:
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the breakdown of muscle fibers resulting in the release of myoglobin into the blood stream.
these myoglobin will clog up the kidneys leading to failure |
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extracellular ions
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sodium
calcium bicarbonate |
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intracellular ions
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potassium
magnesium phosphate |
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sodium potassium pump needs what to function
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ATP and oxygen is needed to function
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leading cause of rhabdomylysis
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natural or human made disasters
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rhabdomylysis treatment
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aggressive fluid rehydration with ISOTONIC crystalloids at 500/hr minimum and 200-300cc/hr urine output
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Rhabdomylysis and sodium bicarb admin
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mix one amp of bicarb in one liter bag of 0.5nss and administer 100cc/hr until pH rises above 7.0
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gram -/+ tests for what?
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sepsis
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most deadly complication of kidney stones
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infected hydronephrosis can rapidly lead to sepsis and death
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a leaking aneurysm may mimic what other condition
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kidney stones
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Foley catheters used for:
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monitoring volume status
assessing renal perfusion |
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adult urinary output
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20-50cc/hr
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number one reason people present to the ER
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non descript abdominal pain
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most serious type of visceral abdominal pain
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ischemic pain which the pain is out of proportion
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When is abdominal palpation contraindicated?
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if an aortic aneurysm is suspected
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Right upper pain
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cholecystitis
pancreatitis renal stones PUD pneumonia PE MI |
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left upper quadrant
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gastritis
ulcer pancreatitis splenic rupture renal stone pneumonia PE MI |
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platelet count requiring transfusion
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if it falls below 50,000
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pancreatitis is what:
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inflammatory process in which the pancreatic enzymes auto digest the gland.
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pancreatitis signs and symptoms
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nausea and vomiting
hypotension tachycardia tachypnea fever right upper abdomen pain going onto back Grey turners sign Cullen sign |
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leading cause of acute liver failure
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drug related hepatoxicity
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most important treatment of acute liver failure:
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to identify the causing factor
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pain from peri umbilical area to right lower abdomen is a strong indicator of what?
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appendicitis
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most AAA begin where and where?
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below the renal arteries and above the iliac arteries
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AAA medications
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HTN:
nitroprusside labetalol BB labetalol propranolol esmolol |
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2 long term feeding tubes
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PEG
PEJ |
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components of central nervous system
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brain and spinal cord
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components of peripheral nervous system
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efferrnt and afferent divisions
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list of neurotransmitters
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acetylcholine
epinephrine norepinephrine |
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large opening at base of cranium
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foremen magnum
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meninges PAD
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Pia
Arachnid Dura |
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receives incoming signals to brain
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thalamus
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hypothalamus
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autonomic control center:
temp control thirst and hunger ADH secretion from petuitary gland. |
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medulla control centers
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cardiac
vasomotor respiratory |
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single episode of this will cause mortality to increase 200%
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single episode of hypoxia
(SPO2 <90%) |
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What is normal ICP value
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5-15mmHg
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measuring CPP
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MAP-ICP=CPP
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allows for collateral circulation in brain if one vessel is occluded
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circle of Willis
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hallmark sign for vertebro-basilsry artery bleed
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vertigo
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What can cross the blood brain barrier
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lipid soluble substances, carbon dioxide, water, and oxygen.
isotonic solutions can cross barrier, colloid solutions cannot |
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causes of increased cerebral blood flow
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hypoxemia
hyperthermia hypercapnia vasodilators |
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causes of decreased CBF
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increased ICP
hypocapnia hypothermia barbituates. |
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expressive aphasia
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inability to express language clearly
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receptive aphasia
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unable to understand language
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