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Air Methods Critical Care exam Questions with verified
correct Answers 2025/
What is the most reliable method of confirming and montioring correct placement of an
ET tube?
Continuous waveform capnography
The upper airway consists of...
Nose, Mouth, Jaw, Oral Cavity, Pharynx, and Larynx
No gas exchange occurs here , it's called.
Nose to terminal bronchioles, anatomical dead space. (2ml/kg of inspired tidal volume)
They conduct airflow towards gas exchange units.
Crycothyroid membrane
between thyroid and cricoid, avascular structure that connects the thyroid and cricoid
cartilage. Site of CRiCOTHYROTOMY- an emergency opening of the airway.
A PaCO2 greater than 45 mmHg indicates:
A. Metabolic acidosis.
B. Metabolic alkalosis.
C. Respiratory acidosis.
D. Respiratory alkalosis.
C. Respiratory acidosis
PaCO2 normal range
35 - 45 mm Hg Less than 35 likely means hyperventilation
Tracheal deviation AWAY from the affected side, decreased breath sounds, and
hyperresonance... What's happening?
Tension pneumothorax
In a tension pneumothorax tracheal deviation goes in what direction?
AWAY from affected side.
Normal mean pulmonary artery pressure
10 - 20 mmHg
Pulmonary hypertension is a mean PA pressure greater than...
(PAm) greater than 20
Primary pulmonary hypertension
Idiopathic genetic disorder caused by abnormal structure of the pulmonary blood
vessels
Name three causes of secondary pulmonary hypertension..
- Passive PH- the result of back pressure. Mitral Stenosis, LV systolic failure.
- Active PH- Constriction of the pulmonary circuit Increased volume in pulmonary
circuit (i.e. congenital heart disease)
- Obstruction as in Chronic recurrent PE
TNP of the Pregnant patient
Resuscitation priorities are the same. The best way to take care of the baby is to take
care of mama
Mechanisms of injury and biomechanics the most common cause of maternal injury is...
Blunt trauma caused by MVC. Second is BT caused by falls, 3rd is violence
fetal distress is an early sign of maternal distress... Why?
Catecholamine mediated vasoconstriction resulting from blood loss shunts blood away
from the fetus to the mom.
Fetal hypo perfusion is evidenced by....
Fetal tachycardia (140 to 160+) and fetal bradycardia
The FRC in a pregnant patient is....
Reduced by the gravid uterus lifting the diaphragm.
chest tube placement in a pregnant patient is 1 - 2 spaces higher
Because of the lifted diaphragm
What is the cause of physiological anemia in pregnant patients?
Hemodilitional anemia occurs. Plasma volume increases 30 - 50%.
Preterm Labor (PTL)
abruptio placentae
premature separation of the placenta from the uterine wall
On a pregnant patient...
Chest compressions must be higher on the sternum.
Any preg patient 20 weeks pregnant or more with a uterus above the umbilicus should
have the uterus left laterally displaced during compressions to avoid aortocaval
compression. A 15 degree tilt of the long board or lateral displacement.
What is the Maternal Fetal Triage Index?
A valid reliable 5 level triage tool that may assist in the triage of obstetric trauma
patients.
Displacing the uterus off the vena cava can improve CO by
approximately 30%!
Continuous fetal monitoring is recommended...
for all pregnant patients 20 or more weeks gestation... or (uterus above belly button).
Fundal height measurement
equals the approximate gestational age in weeks, until week 32.
Belly button is 20 weeks
Height of last rib is 26 weeks
costal margin is 36 weeks
Any fundal height indicating 23 or more weeks...
at the last rib and above is consistent with a viable fetus.
What type of blood should a pregnant trauma patient receive?
O-NEG baybay.
Initiate cardiotocography in any mother
20 or more weeks gestation, must be monitored for at least 6 hours.
What is the serum lab test that detects fetal red cells in the maternal circulation?
Kleinhauer Bette KB serum test. This lab is used to determine if hemorrhage of fetal
blood through the placenta and into maternal circulation. KB test is an important
detector of abruptio placentae, preterm labor and need to administer Rh negative
globulin when mom is Rh negative and fetus is Rh positive.
Continue fetal monitoring for a minimum of ------hours for any viable pregnancy and up to
hours if there is abdominal trauma
Sonography has for diagnosis placental abruption,
POOR. ... they miss 50-80% of abruptions.
AV block in which occasional electrical impulses from the SA node fail to be conducted
to the ventricles.
PR interval progressively lengthens greater than 120 - 200ms + dropped beats.
Maternal cardiopulmonary arrest...If any moribund patient is 24 weeks or more
perimortem c section must be considered. AHA recommends c section initiation within...
4 minutes... delivery with in 5 minutes of any unsuccessful maternal resuscitative
attempts.
Second Degree Heart Block (Mobitz II)
= Damage AT av node - moderate
- PR-interval is normal; QRS complexes are dropped erratically
- ALL must have a pacemaker in the next 72 hrs.
STEMI Nitro gtt
5 - 10 mcg per minute
Titrate by 10 mcg
max dose 300 mcg per minute
How do you mix epi?
Mix 1 mg in 1 L NS or D5W or LR for a concentration of 1 mcg/ ml
What's the epi dose for hypotension
s/p arrest?
0.1 - 0.5 mcg/kg/min
What is the epi dose for anaphylaxis?
Pediatric Epinephrine dose
PALS 2020 update
AHA 2020 BASIC BP
Diastolic BP of at least 25mmhg in infants
and at least 35 mmhm in children
correlates with better outcomes.
PALS Brady with a pulse
Assess airway, breathing, mental status
Most common cause is hypoxia! could also be hypothermia and or medications.
s/s of shock? AMS? hypotensive?
Start CPR if any of these
Always start CPR if HR < 60 bpm
iv access
Give Epi 0.01 mg/kg (0.1ml of 0.1mg/ml solution)
Repeat Q 3-5 minutes
Initial management of pediatric respiratory distress or Failure A
- A-ABC. Support open airway: Comfort or Head tilt chin lift. Jaw thrust.
Clear airway if indicated. (suction nose or mouth if indicated)
Consider OPA or NPA.
IDENTIFY type and Severity of respiratory problems
Initial management of pediatric respiratory distress or Failure B
- B-Monitor Spo2 withPulse ox. Provide high concentration O2, via non rebreather
- Administer inhaled meds: Albuterol or Epi. as needed
- Assist ventilation with child ambu + o2 if needed. Prepare for intubation if needed.
Initial management of pediatric respiratory distress or Failure C
3.C-Monitor heart rate, rhythm and BP. Establish IV/IO access. and fluids/ meds as
needed. Evaluate Identify Intervene
What is an upper airway obstruction?
Interruption in airflow through nose, mouth, pharynx, or larynx. The large always outside
the thorax.
PALS What causes upper airway obstruction?
Airway Swelling
(anaphylactoid rx) ,Infection r/t croup
Aspirated foreign body
enlarged tonsils or adenoids
Decreased level of consciousness GCS of 8?
Infants and small children are especially vulnerable to
Upper airway obstruction.
Infants are obligate nose breathers.
PALS Management of upper airway obstruction
position of comfort, or jaw thrust chin lift
100% FIO2 via non rebreather
- Carefully weigh decision to suction. Don't do it if it's croup of anaphylaxis.
- give nebulizer epinephrine particularly if swelling is beyond the tongue.
- Give inhaled or IV cortical steroids
- OPA for AMS and NPA for ams with a gag.
- consider cpap.
- Only experienced intubation should be considered
ensure pt can be ventilated prior to paralytic
- prepare for difficult airway (needle cricothyroidotomy)
In infants and children, retraction of the skin, muscles, and other tissues around the
clavicle and between the ribs indicates:
A.
shallow breathing.
B.
labored breathing.
C.
see-saw breathing.
D.
normal breathing.
PALS Management of upper airway obstruction caused by croup.
PALS Management of Anaphylaxis
In addition to ABC....
- Administer IM epic by auto injector or regular syringe every 10 to 15 minutes as
needed. Repeat doses may be needed.
- Treat bronchospasm with albuterol MDI or Nebulizer
- Give continuous nebulizer treatment if needed.
- **For severe respiratory distress anticipate further airway swelling and prepare for
endotracheal intubation
PALS Management of anaphylaxis continues
In adults it's bradycardia
Hyperventilate the patient to prevent further increases in ICP
- hypertonic saline, Osmotic agents (dose?)
- Treat pain and agitation aggressively once airway is established.
- Avoid hyperthermia
PALS management of respiratory distress due to poisoning
- Support airway
- give antidote
- call poison control
Ventilation Management
a Tidal volume is 5 - 7mL/Kg aprox. 500ml for an adult
hemodynamic changes in Cardiogenic shock
SBP (Down)
SVR (UP)
CVP (UP)
CO (Down)
PAP (UP)
Wedge (UP)
PVR (UP)
Coags (PT/INR/PTT)
PT 11-14s
PTT (20- 40 sec) heparin
INR (0.9-1.2) Coumadin
Platelets : 150-450k
Blood Gas
pH: 7.35-7.
PaCO2: 35 - 45
PaO2: 80 - 100
HCO3: 22 - 26
chemistry panels (renal, hepatic, comprehensive, metabolic)
Na+ 135- 145
Cl- 95 - 105
K+ 3.5-4.
Cr 0.6-1.
Glucose 70 - 100
Magnesium 1.7-2.
Magnesium
K+ (potassium)
3.5-5.0 mEq/L
Na+
135 - 145 mEq/L
Glucose
70 - 110 mg/dL
Cr (Creatinine)
0.6-1.3 mg/dL
Systemic Vascular Resistance (SVR)
the force opposing the movement of blood within the blood vessels
[(MAP-CVP) / CO] x
Normal: 750 - 1600 dynes/sec
SVR Formula & Normal
(MAP - CVP / ) x 80
Normal 750 - 1600 dynes/sec
hemodynamic changes in Hypovolemic hemorrhagic shock
HR Increased
SBP Decreased
SVR Increased
CVP Decreased
Hemodynamics of septic shock
- CO/CI; INCREASED
- RAP/PAP/PAOP; decreased
- SVR; decreased
- SVO2; INCREASED
Cl (Cloride)
Acute Respiratory Failure blood gases
Calcium
Ca2+ 8 - 10
Hemoglobin (male and female)
Male: 14-18 g/dL
Female: 12 - 16 g/dL
Hemotocrit
percentage of RBC in a volume of blood
Males 45-52%
Females 37-48%
Trick: it's the HGb x 3
Glasgow Coma Scale (GCS)
3 - 15 with 15=good and 3=bad
Brain injury GCS:
Minor 13 - 15
Moderate 9 - 12 Asses ability to protect airway
Severe 3- 8
volume control ACVC
Set Tidal volume and rate, peep, FIO2. Guaranties a set minute ventilation
assist control ventilation
- Has a preset rate and preset tidal volume
- patient CAN breathe on own, uses own breaths
- when patient initiates own breath, vent will give preset tidal volume
- rate depends on patient's ABG's (CO2 level) the higher the CO2, the higher the rate
The apex of the heart- should be a positive deflection.
It's a positive lead that looks at the apex of the heart.
P wave: atrial depolarization
Left bundle branch...
Is what actually depolarizes the intraventricular septum
In lead II, depolarization of the septum ( LBB) is what part of the ekg?
The negative deflection known as the Q wave! The Q wave is indicative of
intraventricular Septal depolarization
The R the wave is indicative of
Ventricular depolarization
SaO
95 - 100% percent of hemoglobin that is saturated with oxygen.
Adult Acls Dopamine infusion dose
2 - 10 mcg/ kg / min
Adult ACLS Epi infusion dose
2 - 10 mcg/kg/min
Adult ACLS Bradycardia Atropine dose
1st dose: 0.5 mg bolus
Repeat q 3 - 5 minutes
Max dose 3mg
Adult ACLS Cardiac Arrest Amio dose:
1st: 300mg bolus
2nd: 150mg
Adult ACLS how many compressions?
At least 100 compressions a minute
Vasopressin push dose & infusion dose
1 dose of 40 units
0.02-0.04 units per minute
Thrombocytopenia
Platelet count of less than < 150,000 uL
Trauma triad of death
- Hypothermia: warm room, warm blanket, warmed fluid
- Coagulapathy
- Metabolic acidosis
DIC Coag Lab values
D-Dimer 1-5 mcg/ml
Fibrinogen < 100 mg/dL (Normal 200 - 400 mg/dL)
Normal PR interval
0.12-0.20 seconds
Normal QRS duration
0.04-0.12 seconds
WBC
Normal is 5 - 10K mm
A normal Q-T interval is.
0.31-0.41 sec when heart rate is 70 beats/min
Has to be corrected for HR
Shockable rhythms
V fib
V tach (pulseless)
Junctional Escape Rhythm
a rhythm that occurs when the SA node fails to initiate the electrical activity and one of
the backup pacemaker sites takes over
Rate 40 - 60 (61- 100 accelerated)
No p wave
ventricular fibrillation
Disorganized, ineffective twitching of the ventricles, resulting in no blood flow and a
state of cardiac arrest.
No pulse. SHOCK Biphasic 200J Mono 360J
monomorphic ventricular tachycardia
QRS complexes that are the same shape, size, and direction.
3rd degree AV block
P wave independent of QRS
Idioventricular Rhythm (IVR)
Rate: 20 - 40
regular
QRS wide and bizarre in shape
escape or usurpation
septic shock and Central VENOUS ScVO2 oxygen extraction
LOW < 65% is bad.
Drawn from a CVC. Surrogate to Svo2.
Normal oxygen extraction is 25 - 30% corresponding to a ScvO2 >65%
< 65% = Impaired tissue oxygenation
80% = High PaO2; or suspect: — Cytotoxic dysoxia (e.g. cyanide poisoning,
mitochrondial disease, severe sepsis) — Microcirculatory shunting (e.g. severe sepsis,
liver failure, hyperthyroidism) — Left to right shunts
Adult Dopamine IV Infusion Dose
- Correct hypovolemia first
- 5 - 20 mcg/ kg / min
- don't use for cardiogenic shock with CHF
- Don't mix with Bicarb
Adult Norepinephrine (levophed) Infusion Dose
0.1- 2 mcg /kg/ min
Adult Lidocaine
VF/VT
1.5mg/kg IVP
Repeat 3 - 5 min
Max 3mg/kg (2 doses)
GTT: 20 to 50 mcg /kg/minute.
1 to 4 mg /minute
Adult Vassopressin Gtt dose
from 0.01 to 0.05 units/min
Most common cause of PEA-
hypovolemia and Hypoxia
Arrest r/t Massive Saddle PE
Give Fibrinolytics
Arrest r/t Cardiac tamponade...
Give volume
tension pneumothorax
TX with needle decompression and chest tube insertion
Fibrinolytics
Alteplase, reteplase and tenecteplase
Administer to patients with STEMI > 2 mm in leads V2 and V
CI (Absolute)
- Active bleeding or bleeding diathesis
- Any prior intracranial hemorrhage
- Recent intracranial or intraspina surgery or trauma (last 3 months)
- Intracranial neoplasm, arteriovenous malformation, or aneurysm
- Arotic dissection
- Sever uncontrolled hypertension
- Ischemic stroke within past 3 months, except acute ischemic stroke within 4.5 hrs.
Relative
- Active peptic ulcer
- Current use of anticoagulant
SE
- Bleeding, hypotension, intracranial hemorrhage, fever
NOTE
- Door-to-needle time should be < 30 mins (for fibrinolytcis)
ACS Heparin
4000 unit bolus (0.8 ml
CI: GI bleeds, SAH, Already taking coumadin, plavix, other d
ACS Metoprolol (Lopressor)
Indications: MI, Tachy, hypertensive
Dose : 5mg slow IV push at 5 minute intervals for a max of 15 mg. long acting,
CI: hypotensive, brady
A lactate level of > is a poor prognostic sign
Lactate > 4
Definition of sepsis, severe sepsis and septic shock
Sepsis: SIRS + Infection
Septic Shock: Severe Sepsis + SBP <90, MAP < 65, or Lactate > 4 after Fluids.
(30ml/kg)
SIRS Criteria (systemic inflammatory response syndrome)
= 2 of the following:
38.3 (100.9F) or < 36 (96.8F)
Heart Rate > 90 bpm
- RR > 20 or PaCO2 < 32 (hyperventilating)
(normal 35-45)
or >10% bands
Naloxone (Narcan)
opiate antagonist, reverses opioid induced resiratory depression
Dose
A.C.L.S. Epinephrine Dosing and indications
Arrest: 1 mg q 3 - 5 minutes 10 mL or 0.1 mg/ml
Higher dose: 0.2 mg/Kg for CCB/BB OD
GTT: 0.1-0.5 mcg/kg/min
Anaphylaxis: 5 - 15 mcg/kg/min
Profound Brady or Hypotension 2 - 10 mcg/Min
ACLS Atropine dose?
Brady with a pulse:
1 mg! q 3- 5 minutes
max dose: 3 mg 0.04mg/kg (3mg)
may not be effective for mobitz 2 or 3rd degree HB
spinal shock
complete but temporary loss of motor, sensory, reflex, and autonomic function
immediately after injury- lasts less than 48hrs- weeks
- flaciddity
- Loss of reflexes
Keep CPP > 60
What are the Stroke care 1 hour goals?
1. NIHSS
- Ct w/o contrast
Door to needle time for ischemic embolic
What three things cause cerebral vasoconstriction?
Hypertension
Hypocarbia
Alkalosis
Which things cause cerebral vasodilation?
Hypotension
Hypercarbia
Acidosis
What MAP range is necessary for cerebral auto regulation to be maintained?
50 - 150 mm Hg
What happens to cerebral blood flow when the patient is hypoxic? ( pao2 less than 50)?
Cerebral vasodilation occurs.
One Evidence of loss of cerebral auto regulation is
Cushings's response:
Widening pulse pressure
Reflex bradycardia
Decreased respiratory efforts
maintain a CPP of to -
to optimize cerebral blood flow
Greater than 65 Usually 70- 90
Normal 60- 100
Acceptable 50 - 70 mm Hg
How do you calculate MAP?
Systolic BP + (2 x DBP) / 3
Which leads look at the inferior surface of the heart? ie RV infarction inferior MI?
II III & aVF
What does an inferior MI look like on EKG?
What are some physical exams you can perform to assess systemic vascular
resistance?
pulse pressure variation
What are Kinematics and why do we care?
Kinematics and the physics of energy transfer
What is dynamic compliance?
Dynamic compliance is static compliance plus airway resistance. bronchospasm would
affect dynamic compliance because it increases airway resistance.Differentiate between
the factors that affect airway resistance and factors that affect expansion of the alveoli,
lung, or chest wall. Dynamic compliance is affected by airway resistance factors.
Commotio cordis is a phenomenon in which:
ventricular fibrillation is induced following blunt trauma to the chest during the heart's
repolarization period.
Ashman phenomenon
Aberrant conduction of a supraventricular beat commonly seen in patients with atrial
fibrillation; wide SV beat after a QRS complex that is preceded by a long pause.
Which of the following may be useful in systolic dysfunction but may be detrimental in
diastolic dysfunction?
A.
β-blockers
B.
Angiotensin-converting enzyme inhibitors
C.
Aldosterone antagonists
D.
Vasodilators
Vasodilators are used for preload and afterload reduction in systolic dysfunction but
may detrimentally decrease diastolic filling in diastolic dysfunction.
A holistic murmur at the left sternal border means the
the tricuspid valve is most likely affected.
a patient with valve vegetation from IV venous drug use is most likely to have vegetation
on what valve? resulting in risk of which condition...
the Tricuspid valve... Pulmonary emboli
the valve most likely affected in this patient is the tricuspid valve and that the blood (and
any emboli) will go to the pulmonary artery and the lungs. E
Which of the following is a cause of diastolic dysfunction?
A.
Cardiac tamponade
B.
Myocardial infarction
C.
Hypertension
D.
Aortic stenosis
Diastolic dysfunction is an inability of the heart to fill adequately. Tamponade
compresses the chambers so that filling is impaired. If filling is impaired, cardiac output
is diminished.
Which single lead is the most valuable for the diagnosis of ventricular tachycardia?
A.II
B.V
C.V
D.III
Because ventricular tachycardia is most likely to originate in the left ventricle, lead V1,
which is normally predominantly negative, would be predominantly positive in ventricular
tachycardia.
Leads II and III, both inferior leads, are too similar for either to be correct. Because the
A lateral Wall MI will be seen as St elevations in which leads, and stems from a
blockage in which coronary arteries?
- High Lateral: lead 1 and AVL
V5 and V6 are low lateral wall... ischemia from the circumflex artery.
In Acute coronary Syndromes unstable angina is characterized by......
- Ischemic Symptoms suggestive of ACS
- No Troponin elevation
- with or without ECG changes
NSTEMI characteristics
universal recipient blood type is...
AB positive
universal donor blood type
O negative
Rh disease (erythroblastosis fetalis)
RhoGAM shot
given to mother soon after the first delivery, miscarriage, or abortion so that antibody
binds to fetal RBC and removed it from the body before the mother makes Rh antibody
What type of blood is given to women of childbearing age?
Platelets indications
volume in the bag is about 150 mls, to assist with coagulation of blood. idications:
bleeding, hemophelia, thrombocytopenia, platelets dysfunction
FFP (fresh frozen plasma) 150 - 160ml
indications: pts who need coagulation factors - liver failure, DIC, Burns, massive RBC
transfusion
Product of choice for pts with multiple deficiencies
Cryoprecipitate 50ml
- Clients with hemophilia (deficiency of clotting factor), are given cryoprecipitate to
replace the deficient factor as a prophylactic measure before any invasive procedure,
surgery or when actively bleeding.
- Cryoprecipitate provides therapeutic amounts of Facto 8, Factor 13, von Willebrand
factor and fibrinogen. These concentrates are made with recombinant DNA technology
and are the treatment of choice with hemophilic A and von Willebrands disease.
Indications for Fresh Frozen Plasma
Burns,
