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AIR METHODS CRITICAL CARE FULL ACTUAL EXAM 300+ VERIFIED QUESTIONS WITH
SOLUTIONS GRADED A (NEW VERSION)
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. 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
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 normal QRS axis is down and to the left, causing a predominantly positive QRS complex in lead V6 but a predominantly negative QRS complex in lead V1, choose lead V1. On a pulmonary artery waveform, the dicrotic notch represents closure of which valve? A. Aortic valve B. Pulmonic valve C.
Tricuspid valve D. Mitral valve In a pulmonary artery waveform the three components of the waveform are systole, dicrotic notch, and diastole. Systole is the pressure generated by the right ventricle so that the pulmonic valve will be pushed open, the dicrotic notch is caused by the closure of the pulmonic valve, and diastole is the pressure in the pulmonary artery during ventricular diastole. The diastolic pressure is a reflection of the vascular tone in the pulmonary vascular bed. If the vessels are constricted or if there is back pressure from the left side of the heart, the diastolic pressure will be high. A 36 yo patient presents in VTACH what is the most appropriate drug? A.Amiodarone (Cordarone) B.Verapamil (Calan) C.Adenosine (Adenocard) D.Ibutilide (Corvert) The first drug for a wide QRS complex tachycardia is amiodarone. If the rhythm does not respond to amiodarone, synchronized cardioversion is indicated. Verapamil and adenosine typically are used for narrow QRS complex tachycardia. Eliminate options b and c. Ibutilide is used for acute-onset atrial fibrillation. This rhythm is regular, so eliminate option d and choose option a. An S4 is noted during cardiac auscultation. This sound indicates: A.
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, Normal mean pulmonary artery pressure 10 - 20 mmHg Pulmonary hypertension is a mean PA pressure greater than... (PAm) greater than 20
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.
Prothrombin (PT ) and PTT and serial coags should be drawn. Beta Human Chorionic gonadotropin (BHCG) Measure and record fundal height every 30 minutes. Pediatric Mechanisms of injury and biomechanics Blunt trauma MVC > suffocations > drownings > fires/burns. No. 1 cause of fatalities is TBI. Primary Survey/ Resuscitation Survival rates in pediatric emergency can be directly correlated with 1.RAPID AIRWAY MANAGEMENT, 2.INITIATION OF VENTILATORY SUPPORT, AND 3.EARLY RECOGNITION OF AND EARLY RESPONSE TO INTRA abdominal AND intracranial hemorrhages A STEMI is a __________ resulting from a _________. Complete Occlusion of a coronary artery caused by a ruptured Plaque leading to blood clot formation in the coronary.
STEMI diagnosis Chest pain + positive cardiac enzyme (TROP. >0.4), and --ST segment ELEVATIONS greater than 1 mm in two or more contagious leads V1-V
- Reciprocal (depressions) changes in leads II, III, AVF STEMI EKG findings STEMI STEMI EKG findings more
- St elevations > 1mm in Limb leads: 1, II, III, avF, avL
- St elevations > 2mm in precordial leads (v1-v6) AND/OR
- NEW LBBB Contiguous leads with reciprocal changes in opposite leads First degree Heart Block EKG AV block Prolonged PR Interval greater than 120-200 ms
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 RSI drugs paralytics Rocuronium 1mg/ Kg Onset 1 minute Duration 30 minutes
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
