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Critical Care Paramedic Exam 2024/2025 Detailed Questions And Expert Answers
Typology: Exams
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Normal pH - ANS>7.35-7. Normal CO2 - ANS>35- Normal HCO3 - ANS>22-26 (good dating age) Normal PaO2 - ANS>80- Normal SaO2 - ANS>> 95% Base (deficit/excess) - ANS>(-2) - (+2) Buffer systems: Bicarb reaction time - ANS>seconds Buffer systems: Lungs reaction time - ANS>minutes Buffer systems: Kidneys reaction time - ANS>hours to days
Minute volume calculation - ANS>Tidal volume x respiratory rate pCO2 >45 - ANS>acidotic pCO2 <35 - ANS>alkalotic HCO3 <22 - ANS>acidotic HCO3 >26 - ANS>alkalotic base deficit of < -4 - ANS>indicator for the potential need for blood transfusion base deficit of < -19 - ANS>indicates poor outcome (death likely) base deficit replacement formula - ANS>0.1 x (-BE) x patient weight in kg = bicarb needed PO2 of 60 is roughly equivalent to a SaO2 of - ANS>90% critical pH for intubation - ANS>< 7.
Hypoxia, extremes of size, anatomic challenges, vomit/blood/fluid, exsanguination, neck mobility issues ramping - ANS>ear to sternal notch without ramping during intubation or transport causes a potential for - ANS>decrease in functional reserve capacity, tidal volume, and preload Sellick's maneuver and BURP - ANS>no longer recommended External laryngeal manipulation (ELM) - ANS>current standard of practice bougie adult size - ANS>15 Fr bougie pediatric size - ANS>10 Fr bougie neonatal size - ANS>6 Fr supraglottic devices - ANS>provide little protection against aspiration ETT cuff pressure - ANS>20-30 mmHg (25 is standard)
gold standard of confirming ET placement - ANS>chest X-Ray distal tip of ET - ANS>2-3 cm (1 inch) above carina, at T3 or T 7 p's for RSI success - ANS>preparation, preoxygenation, pretreatment, paralysis with induction, protect/position, placement (with proof), post intubation management LOAD - ANS>pretreatment for RSI lidocaine, opiates, atropine (infants), defasiculating dose fentanyl adult dose - ANS>1 mcg/kg fentanyl onset - ANS>3-5 mins fentanyl post intubation management - ANS>0.5 - 1.5 mcg/kg every 5 minutes fentanyl post intubation management infusion - ANS>1-3 mcg/kg/hour fentanyl reversal agent - ANS>narcan
versed adult dose - ANS>2.5-5 mg versed onset - ANS>30-60 seconds versed duration - ANS>15-30 minute duration versed post intubation management - ANS>2-5 mg versed post intubation management infusion - ANS>0.05 - 0. mg/kg/hour versed reversal agent - ANS>flumazenil (romazicon) 0.2 mg propofol (diprivan) adult RSI dose - ANS>1-2 mg/kg propofol (diprivan) adult maintenance dose - ANS>25-50 mcg/kg/min propofol (diprivan) onset - ANS>15-45 seconds propofol (diprivan) duration - ANS>5-10 minutes
propofol (diprivan) cautions - ANS>hemodynamically unstable patients succinylcholine (anectine) - ANS>depolarizing neuromuscular blocker agent succinylcholine (anectine) can cause - ANS>fasciculations hyperkalemia succinylcholine (anectine) requires - ANS>refrigeration succinylcholine (anectine) contraindications - ANS>crush injuries, eye injuries, narrow-angle glaucoma, malignant hyperthermia, burns > hours old, hyperkalemia, Guillain- Barre, Myasthenia gravis succinylcholine (anectine) adult dose - ANS>1-2 mg/kg (max 150) succinylcholine (anectine) onset - ANS>< 1 minute succinylcholine (anectine) duration - ANS>4-6 minute duration
Vecuronium (Norcuron) - ANS>non-depolarizing neuromuscular blocking agent Vecuronium (Norcuron) use - ANS>used after sux or rox to keep the patient paralyzed Vecuronium (Norcuron) adult dose - ANS>0.15 mg/kg Vecuronium (Norcuron) adult maintenance dose - ANS>0.01 - 0.1 mg/kg Vecuronium (Norcuron) does not require - ANS>refrigeration Vecuronium (Norcuron) onset - ANS>90-120 seconds Vecuronium (Norcuron) duration of action - ANS>60-75 minutes RSI for hemodynamically unstable patients - ANS>1/2 the induction dose, double to paralytic SALAD - ANS>Suction assisted laryngoscopy airway decontamination
under 8 years old - ANS>needle cricothyrotomy tidal volume (Vt) - ANS>how much air the patient breathes in a normal breath Inspiratory Reserve Volume (IRV) - ANS>Amount of air that can be forcefully inhaled after a normal tidal volume inhalation Expiratory Reserve Volume (ERV) - ANS>Amount of air that can be forcefully exhaled after a normal tidal volume exhalation Vital Capacity (VC) - ANS>TV + IRV + ERV Residual Volume (RV) - ANS>amount of air left in lungs after maximum expiration Total Lung Capacity (TLC) - ANS>RV + VC (TV + IRV + ERV) Dead space - ANS>the surfaces of the airway that are not involved in gas exchange (anything other than alveoli) Dead space formula - ANS>2 ml/kg
gold standard for oxygenation - ANS>pulse ox (SPO2) gold standard for ventilation - ANS>capnography (ETCO2) number one cause of iatrogenic death in US - ANS>ventilator acquired pneumonia (VAP) once a patient is on a ventilator - ANS>confirm settings with ABG hypoxic respiratory failure - ANS>inability to diffuse O ARDS, pneumonia, CHF hypoxic respiratory failure finding - ANS>low PO2, < 60 mmHg hypoxic respiratory failure treatment - ANS>increase O2 concentration and PEEP hypercarbic respiratory failure - ANS>inability to remove CO stroke, trauma
hypercarbic respiratory failure finding - ANS>respiratory acidosis, ETCO
45 mmHg hypercarbic respiratory failure treatment - ANS>increase tidal volume (Pplat), then increase rate Vent settings: tidal volume (Vt) - ANS>4-8 cc/kg IBW Vent settings: Rate (F) - ANS>12-20/min Vent settings: Minute Volume (Ve) - ANS>F x Vt Vent settings: Inspiratory : Expiratory Ratio (I:E) - ANS>1: Fraction of Inspired Oxygen (FIO2) - ANS>0.21 to 1. Vent settings: Positive End Expiratory Pressure (PEEP) - ANS>0-20 cm H2O Ventilator delivery methods: Volume (tidal volume) - ANS>pressures are continuously monitored
caused by hyperventilating on an AC vent setting Synchronized Intermittent Mandatory Ventilation (SIMV) - ANS>assisted mechanical ventilation synchronized with the patients breathing, machine knows when patient takes a breath and will patient fails to take a breath the vent will provide one preferred for patients with intact respiratory drives Pressure Support Ventilation (PSV) - ANS>pressure support makes it easier for the patient to overcome the resistance of the ET tube often used while weaning supports/provides pressure during inspiration to decrease patients overall work of breathing DOPES - ANS>ventilator alarm Dislodged (low), obstructed (high), pneumothorax (high), equipment, stacked breaths (high) low pressure alarm - ANS>patient disconnection from machine, chest tube leak, circuit leak, airway leak, hypovolemia high pressure alarm - ANS>kinked line, coughing, secretions/mucus in airway, biting the tube, reduced lung compliance (ARDS, pneumonia), increased airway resistance
Patient-Ventilator Dyssynchrony causes - ANS>respiratory demands not being met, inadequate pain control, inadequate sedation Patient-Ventilator Dyssynchrony effects on patient - ANS>^ work of breathing, ^ oxygen demand, ^ heart rate, ^ blood pressure can lead to ^ ICP (CVAs) Patient-Ventilator Dyssynchrony sign - ANS>Curare Cleft on waveform cap Patient-Ventilator Dyssynchrony treatment - ANS>manage auto-PEEP, adjust sensitivity, adjust rate to match patients demand, adjust minute volume, suction, administer analgesia and sedation Richmond Agitation Sedation Scale (RASS) - ANS>used in mechanically ventilated patients to avoid under/over-sedation -5 (unarousable) to 4 (combative) Tuberculosis PPE - ANS>gloves, N95, gown, eye protection Ventilation/perfusion ratio (V/Q ratio) - ANS>ratio of alveolar ventilation and blood traveling through the capillaries
asthma findings - ANS>flattened diaphragm on chest xray shark fin on waveform asthma treatment - ANS>increase I:E ratio to 1: ZEEP (zero PEEP) initially (<5 or BiPap) High flow O bronchodilators, steroids, epi, mag, IV fluids, ketamine for sedation COPD can lead to - ANS>respiratory acidosis COPD findings - ANS>flattened diaphragm on chest xray COPD exacerbation treatment - ANS>increase I:E ratio to 1: ZEEP (zero PEEP) initially (<5) High flow O bronchodilators, steroids, IV fluids, ketamine for sedation Pneumonia xray findings - ANS>pleural effusions lobar consolidation patchy infiltrates
causes of acute respiratory distress syndrome (ARDS) - ANS>pancreatitis, sepsis, trauma, aspiration pneumonia acute respiratory distress syndrome (ARDS) chest xray findings - ANS>ground-glass appearance patchy infiltrates bilateral diffuse infiltrates acute respiratory distress syndrome (ARDS) Swann-Ganz - ANS>increased PAWP (18-20 mmHg) acute respiratory distress syndrome (ARDS) treatment - ANS>oxygenation increase PEEP (>10) and increase FiO increase rate (F) usually require prolonged inspiratory time normal Na+ - ANS>135-145 mEq/L normal K+ - ANS>3.5-5.0 mEq/L
