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PLATINUM FINAL EXAM EMTP 3.3 REVIEW 2024 VERSION | ALREADY GRADED A+, Exams of Aviation

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PLATINUM FINAL EXAM EMTP 3.3 REVIEW 2024 VERSION | ALREADY GRADED A+

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1. What is the best

airway device to

use for smoke in-

halation?

2. Most pertinent

piece of informa-

tion in evaluating

a patient's venti-

latory status?

3. Most pertinent

piece of informa-

tion in evaluating

a patient's oxy-

genation status?

Endotracheal intubation is frequently needed for support-

ive therapy in the management of inhalation injury.

Ventilation is the movement of air in and out of the lungs

through a patent airway. The majority of observations re-

garding ventilation focus on the movements of the chest.

SIGNS OF ADEQUATE VENTILATION:

In most patients, your assessment of ventilation will be

based on observing their respiratory rate (normal 12 to

20) and listening for clear breathing sounds in the left and

right chest. Auditory confirmation of breathing sounds is

the strongest sign of adequate ventilation. In patients on

ventilators or bag-valve-mask, this does not change.

Oxygenation is the delivery of oxygen to the tissues of

the body, poor ventilation or respiration will generally lead

to poor oxygenation. Loss of oxygenation is the ultimate

result of ventilatory or respiratory failure. You need to ob-

serve the patient's mental status, skin color, oral mucosa,

and check a pulse oximeter.

Mental status is either normal or abnormal, assessing

mental status is based on asking questions about who the

person is, what time/date it is, where they are, and why

they are here.

Skin and mucosal color are important indicators of oxy-

genation. Just as with poor respiration, cyanosis, pallor,

or mottling are signs of decreased oxygen delivery.

Pulse oximetry level is the most objective measure of oxy-

genation, it reads the saturation of hemoglobin (reported

as SPO2), note that a pulse oximeter is not foolproof.

A patient with poor oxygenation in the limbs may have

sufficient oxygenation to their core or vise-versa. Pulse

oximeters can also be fooled by specific toxic gases.

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1. What is the best airway device to use for smoke in- **halation?

Most pertinent** piece of informa- tion in evaluating a patient's venti- **latory status?
Most pertinent** piece of informa- tion in evaluating a patient's oxy- genation status? Endotracheal intubation is frequently needed for support- ive therapy in the management of inhalation injury. Ventilation is the movement of air in and out of the lungs through a patent airway. The majority of observations re- garding ventilation focus on the movements of the chest. SIGNS OF ADEQUATE VENTILATION: In most patients, your assessment of ventilation will be based on observing their respiratory rate (normal 12 to 20) and listening for clear breathing sounds in the left and right chest. Auditory confirmation of breathing sounds is the strongest sign of adequate ventilation. In patients on ventilators or bag-valve-mask, this does not change. Oxygenation is the delivery of oxygen to the tissues of the body, poor ventilation or respiration will generally lead to poor oxygenation. Loss of oxygenation is the ultimate result of ventilatory or respiratory failure. You need to ob- serve the patient's mental status, skin color, oral mucosa, and check a pulse oximeter. Mental status is either normal or abnormal, assessing mental status is based on asking questions about who the person is, what time/date it is, where they are, and why they are here. Skin and mucosal color are important indicators of oxy- genation. Just as with poor respiration, cyanosis, pallor, or mottling are signs of decreased oxygen delivery. Pulse oximetry level is the most objective measure of oxy- genation, it reads the saturation of hemoglobin (reported as SPO2), note that a pulse oximeter is not foolproof. A patient with poor oxygenation in the limbs may have sufficient oxygenation to their core or vise-versa. Pulse oximeters can also be fooled by specific toxic gases.

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4. Most important assessment in evaluating a pa- tient's oxygen delivery to the **brain?

What is the next** step to take if a patient's breath- ing does not im- prove with an **NRB?
What is the next** step to take af- ter opening the airway of an un- responsive pa- tient with slow, shallow respira- **tions?
Know your venti-** **lation rates
Flow rates for 02** devices: Always ensure that you match up your pulse oximetry readings with physical findings and ensure they support one another. Pulse oximeters are imperfect and are not a real-time measure of O2 saturation Prior to applying supplemental oxygen, objective data regarding patient status should quickly be obtained such as airway patency, respiratory rate, pulse oximetry, and lung sounds. Signs of cyanosis in the skin or nail bed assessment should also be noted. BVM After manually opening an unconscious patient's airway, you should: check the mouth for secretions, foreign bod- ies, or dentures. If clear, then started manually ventilating! Adult: 12-20/minute Child: 15-30/minute Infant: 25 - 50/minute Nasal Cannula - 2 - 6L/min Nebulizer - 6 - 8L/min Non-ReBreather - 10 - 15L/min BMV - 15L/min EndoTracheal Tube - 15L/min King LTS-D - 15L/min CPAP - 25L/min (oxygen port)

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tion device given a scenario: Nasal Cannula

14. When to use what airway de- vice given a sce- nario / When to use what ventila- tion device giv- en a scenario: **Non-Rebreather

When to use** what airway de- vice given a sce- nario / When to use what ventila- tion device given **a scenario: BVM
TX of a patient** in anaphylaxis when epineph- rine has failed to improve the pa- tient's condition and he/she is de- **teriorating
Know the advan-** tages and dis- advantages of a surgical vs nee- dle cricothyroto- my. Which one is the quickest to perform? Used for patients that require more than 6L of oxygen, and can be used with a nebulizer for maximum efficiency. BLS airway that is used initially before an advanced air- way, and connected to one if one is placed. If 0.3mg IM 1:1000 Epi does not work, peripheral perfu- sion isn't good enough to circulate the medication! IV EPI: 1:10,000 is the only solution to get the epinephrine to the patient. Once established, surgical cricothyroidotomy has a num- ber of advantages over use of a cannula - provision of a definitive airway (protection by a cuffed tube) being just one. Despite this, the technique is used far less frequently. This may be due to fears about the complication of hem- orrhage. Research suggests that needle cricothyroidotomy can provide effective ventilation in the presence of increasing airway obstruction. The failure of the needle systems in

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18. Assessment findings in a patient with a spontaneous **pneumothorax

Best method to** protect a pa- tient's airway who vomits each time you try to in- **tubate
What are the ad-** vantages / disad- the presence of upper airway obstruction results from inadequate exhalation via the narrow 1.5mm lumen of the 13G cannula. Which can lead to: Barotrauma/pneumothorax = from over-inflation* Bleeding Subcutaneous emphysema Survey data from the prehospital and hospital settings show the needle airway to be the most frequently used emergency cricothyroidotomy method, whereas the sur- gical airway is rarely used. Shortness of breath, sudden onset of sharp chest pain, pallor, tachypnea, diaphoresis. Severe symptoms include tachycardia, AMS, cyanosis, decreased breath sounds on the affected side. Inadequate depth of anesthesia or unexpected responses to surgical stimulation may evoke gastrointestinal motor responses, such as gagging or recurrent swallowing, in- creasing gastric pressure over and above LOS pressure facilitating reflux. In the setting of aspiration, regurgitation occurs three times more commonly than active vomiting. An unprotect- ed airway, excessively light depths of anesthesia, and one or more predisposing risk factors for aspiration combine to significantly increase the risks of aspiration. A summary of the available strategies for reducing aspi- ration risk: Reducing gastric volume (NRB instead of BVM) Second-generation supra-glottic airway devices Cricoid pressure Rapid sequence induction Position (left lateral, head down or upright) Insertion of a supraglottic airway device is simpler and faster than tracheal intubation, and proficiency requires

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23. What is the first assessment you perform for each and every pa- **tient?

What to do if** a patient cannot **tolerate a NRB
First step in** treating a diabet- ic patient who has overdosed and has slow, shallow respira- **tions
Why would** a capnography reading start to decrease in an artificially ventilated pa- tient? Know your ETCO2 values

PRIMARY SURVEY/RESUSCITATION:

Verbalizes the general impression of the patient Determines responsiveness/level of consciousness (AVPU) Determines chief complaint/apparent life-threats 1 - 2. Assesses airway and breathing: Assessment Assures adequate ventilation Initiates appropriate oxygen therapy

Assesses circulation: Assesses/controls major bleeding Checks pulse Assesses skin [either skin color, temperature or condition]
Identifies patient priority and makes treatment/trans- port decision Switch to a nasal cannula at a max of 6L flow rate. Assess and support ABCs: Begin mouth-to-mask rescue breathing. If your patient is breathing at a rate above 20 breaths per minute, they're eliminating a lot more CO2 than average. This excess elimination results in a decreased concentra- tion of carbon dioxide in the body.

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and how it corre- lates to ventilato- ry status.

27. Which respirato- ry sound would be most con- cerning in a pa- tient with a pos- sible allergic re- **action?

S/S of pneumo-** nia Absence of lung sounds (from field experience) Assessment: A patient with bacterial pneumonia will gen- erally appear ill. He may report a recent history of fever and chills. These chills are commonly described as "bed shaking." There is usually a generalized weakness and malaise. The patient will tend to complain of a deep, productive cough and may expel yellow to brown sputum, often streaked with blood. Many cases involve associated pleuritic chest pain. Therefore, pneumonia should be considered in any pa- tient who presents complaining of chest pain, especially if accompanied by fever and /or chills. In pneumonia involv- ing the lower lobes of the lungs, a patient may complain of nothing more than upper abdominal pain. Physical examination will commonly reveal fever, tachyp- nea, tachycardia, and a cough. Respiratory distress may be present. Auscultation of the chest usually demon- strates crackles (rales) in the involved lung segment, although wheezes or rhonchi may be heard. There usu- ally is decreased air movement in the areas filled with infection. Percussion of the chest may reveal dullness over these areas. Egophony (a change in the spoken "E" sound to an "A" sound on auscultation) may also be noted. In the forms of pneumonia involving viral, fungal, and rare bacterial causes, the typical symptoms as described are not seen. Instead, these patients may report a nonpro-

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32. What to do if nee- dle decompres- sion does not correct a ten- sion pneumotho- rax and patient is **deteriorating

S/S of Respirato-** **ry distress
S/S of Respirato-** ry failure sure and an initial increase in heart rate. The increased blood pressure then signals the carotid and aortic barore- ceptors to activate the parasympathetic nervous system, causing the heart rate to decrease. As the pressure in the brain continues to rise, the brain stem may start to dysfunction, resulting in irregular respirations followed by periods where breathing ceases completely. This progres- sion is indicative of a worsening prognosis. Cushing's triad is characterized by a widened pulse pres- sure (decreased), bradycardia, and irregular respirations (also known as Cheyne-Stokes respirations). Ventilations Guided by ETCO
- Target: 35 - 40 mmHg TBI (rate ~10bpm)*
- Target: 30 - 35 mmHg (suspected herniation) (rate~20)*
- Breathing In some instances, it will be necessary to perform needle chest decompression multiple times on the same casual- ty, as time allows. Multiple attempts become necessary when the catheter kinks, becomes obstructed by a clot, or in some other way fails to serve its intended purpose. At all reassessments, evaluate your treatments for effec- tiveness. Check chest seals for suck and blow. Observe whether the needle chest decompression produces a whooshing sound. Nasal Flaring (infants), Cyanosis (possible)/ Pale skin color improves with O2, Retractions (see-saw breathing), Noisy Breathing, Mood Change, and Tripod (possibly), Increase Respirations, Increased work of breathing (early signs), Head bobbing.
- BN Rapid Breathing, bluish-colored skin, lips, and capillary beds (late sign in respiratory failure), tiredness, tachy to bradycardia, deterioration of everything, tachypnea to

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bradypnea, retraction to agonal

BN

TX for epiglottitis Epiglottitis is an acute infection and inflammation of the epiglottis and is potentially life threatening. (Recall that the epiglottis is a flap of cartilage that protects the airway during swallowing.) Epiglottitis, unlike croup, is caused by a bacterial infec- tion, usually Haemophilus influenza type B. As a result of the availability of H. influenza vaccination, epiglottitis has become an uncommon occurrence. When it does occur, it tends to strike children three to seven years old. Cannot agitate the airway by checking or the airway will close off and will require immediate advanced airway placement. 36. Pathophysiolo- gy of an asthma attack Regardless of the asthma trigger type, the response is characterized by inflammation, edema, bronchoconstric- tion, and buildup of mucus in the airways, leading to coughing, wheezing, chest tightness, and shortness of breath. There are two phases of an asthma exacerbation, which include the early phase and late phase.

The early phase is initiated by IgE antibodies that are sensitized and released by plasma cells. When a pollutant or risk factor gets inhaled, the mast cells release cy- tokines and eventually de-granulate. Released from mast cells are histamine, prostaglandins, and leukotrienes. These cells, in turn, contract the smooth muscle and cause airway tightening.
Within the next several hours, the late phase occurs, which eosinophils, basophils, neutrophils, and helper and memory T-cells all localize to the lungs as well, which perform bronchoconstriction and cause inflammation. As a result of inflammation and bronchoconstriction,

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with no signs of allergic reaction! RSV mediated bronchi- olitis also appears with outbreaks during the winter and early spring, with a peak in January! Bronchiolitis is only supportive care, where asthma can be treated with A&A, or further down the allergic reaction algorithm with 1:1000 epinephrine if truly severe. Wheezes are continuous, high-pitched musical sounds similar to a whistle. They result when air moves through partially obstructed smaller airways. Their causes include asthma, bronchospasm, and foreign bodies. You may hear them without a stethoscope or by auscultating the chest during any or all phases of the respiratory cycle. They often originate in the small bronchioles and first appear at the end of exhalation. The closer to inspiration they appear, the worse your patient's condition.

S/S of an MI Assessment:
- Chest pain-May radiate to left shoulder/arm, jaw, back
- Abdominal pain
- Mistaken for indigestion
- SOB, diaphoresis, nausea, palpitations, syncope, anxi- ety, agitation, sense of impending doom Some may have minor or NO symptoms (Silent MI)
- Women, Diabetics, and the Elderly** Atypical symptoms: Neck pain, burning or sharp pain, fatigue/ weakness, nausea, etc. Shortness of breath = anginal equivalent with diabetics 41. S/S of pericardi- tis Symptoms include:
  - Sharp or piercing chest pain over the center or left side of the chest
  - More intense pain while breathing
  - Shortness of breath when reclining
  - Heart palpitations
  - Low grade fever
  - An overall sense of weakness and fatigue
  - Cough

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42. S/S of stable **angina

Be able to iden-** tify Sinus Brady- cardia and the treatment for it. Know your ACLS protocols!
- Feeling sick
- Abdominal or leg swelling An umbrella term for any condition where there is an acute reduction or blockage of blood flow to the heart. Includes: Stable Angina, Unstable Angina, NSTEMI, and STEMI. The progressive narrowing of the lumen of the coronary arteries causes this spectrum of diseases, and the severity of clinical symptoms is dependent on the location and extent of narrowing. Stable angina is defined as transient, episodic chest discomfort resulting from myocardial ischemia. The dis- comfort is typically predictable and reproducible, with the frequency of attacks constant over time. The discomfort is frequently provoked by physical exertion or intense emotional stress. These episodes usually resolve with the use of palliative maneuvers such as rest or medications (nitrates) to open the coronary arteries and relieve the symptoms. During an episode of stable angina, you may also experi- ence: shortness of breath nausea fatigue dizziness profuse sweating anxiety STABLE/UNSTABLE
1. Oxygen (if O2 sat < 90%)
2. ECG, Vital Signs
3. IV
4. Identify and Treat Underlying Cause
5. Atropine 1 mg (repeat every 3 - 5 min (max 3 mg)
6. Premedicate a. Versed 0.1 mg/kg (no more than 5 mg single dose) ( mg max)

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and the treat- ment for it. Know your ACLS proto- cols!

Be able to identify ATRIAL FIBRILLA-
1. Adenosine 6 mg, 12 mg (rapid IV push followed by 10cc flush)
2. Calcium channel blocker (choose one) a. Diltiazem 0.25 mg/kg over 2 min OR b. Verapamil 2.5 - 5 mg over 2 min (double the dose in 15
- 30 min) OR
1. Beta blocker (choose one) a. Metoprolol 5 mg over 5 min (repeat q 15 min to a max of 15 mg) OR b. Labetalol 10 - 20 mg slow IV (repeat in 10 min at 40 - 80 mg) OR c. Propanolol 1 - 3 mg over 2 - 5 min (max 1 mg/min) ———————————— UNSTABLE
2. Oxygen (if O2 sat <90%)
3. ECG, Vital Signs
4. IV
5. Premedicate (choose one) a. Versed 0.1 mg/kg (no more than 5 mg single dose) ( mg max) OR b. Etomidate 0.3 mg/kg
6. Synchronous cardioversion 50 - 100, 200, 300, 360 J *** WPW - Consult Medical Control STABLE Rate greater than 150 (Rates less than 150 generally not treated in the field)

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TION/ATRIAL

FLUTTER with RAPID VENTRICULAR RESPONSE and the treatment for it. Know your ACLS protocols!

Oxygen (if O2 sat < 90%)
ECG, Vital Signs
IV
Calcium channel blocker (choose one) a. Diltiazem 0.25 mg/kg over 2 min OR b. Verapamil 2.5 - 5 mg over 2 min (double the dose in 15

30 min) OR

Beta blocker (choose one) a. Metoprolol 5 mg over 5 min (repeat q 15 min to a max of 15 mg) OR b. Labetalol 10 - 20 mg slow IV (repeat in 10 min at 40 - 80 mg) OR c. Propanolol 1 - 3 mg over 2 - 5 min (max 1 mg/min) *** May have to slow rate with Adenosine in order to differentiate from SVT *** Calcium Channel blockers are preferred over Beta blockers ———————————— UNSTABLE
Oxygen (if O2 sat < 90%)
ECG, Vital Signs
IV
Premedicate (choose one) a. Versed 0.1 mg/kg (no more than 5 mg single dose) ( mg max) OR b. Etomidate 0.3 mg/kg

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Be able to iden- tify PULSELESS V TACH AND V FIB and the treat- ment for it. Know your ACLS proto- cols!

UNSTABLE

Oxygen (if O2 sat < 90%)
ECG, Vital Signs
IV
Premedicate (choose one) a. Versed 0.1 mg/kg (no more than 5 mg single dose) ( mg max) OR b. Etomidate 0.3 mg/kg
Synchronous cardioversion 120 - 200, 300, 360 J
CAB's
CPR
Quick look with or pads
Confirm V Fib or pulseless V Tach
Defibrillate 360 J -
CPR x 2 min (5 cycles of 30:2) IV, ETT, ECG (do not interrupt CPR except for intubation

10 sec)

Check Rhythm
Defibrillate 360 J
Epinephrine 1 mg of 1:10,000 (repeat q 3 - 5 min)
Defibrillate
Amiodarone 300 mg (dilute in 10 mL NS) (repeat @ 150 mg in 3 - 5 min) - max 2.2 G in 24 hrs OR Lidocaine 1 - 1.5 mg/kg (repeat @ 0.5 - 0.75 mg/kg in 3 - 5 min)
Defibrillate - 360 J *** Magnesium Sulfate 1 - 2 g over 1 - 2 min for Torsades (No Amiodarone) *** Perform 2 minutes of CPR after each shock - Do Not

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49. Be able to identify PULSE- LESS ELECTRI- CAL ACTIVITY and the treat- ment for it. Know your ACLS proto- **cols!

Be able to iden-** tify ASYSTOLE Check Pulse *** Drugs should be prepared and administered during CPR - Do not delay shock. *** Check rhythm before each shock; if rhythm changes check pulse ———————————— *** After ROSC ¢ administer 1 - 2 L fluid bolus to maintain a BP of 90 systolic ¢ O2 Sat 92% - 98% ¢ Target PETCO2 to 35 - 45 mm Hg *** May hang a maintenance drip after arrhythmias have been resolved *** Amiodarone Maintenance Infusion
- Run at 1 mg/min for first 6 hours
- Mix 150 mg in a 100 mL bag of NS
- 1mg/min = 33 mL/hr = 40 gtts/min (60 gtt set) for first 6 hours *** Procainamide Maintenance Infusion
- Run at 1 - 4 mg/min
- 1 G in 250 mL - (4 mg/mL)
- 1 G in 500 mL - (2 mg/mL) *** Lidocaine Maintenance Infusion
- Run at 1 - 4 mg/min
1. CAB's
2. CPR
3. Quick look with pads
4. Continue CPR
5. IV, ETT, ECG
6. Epinephrine 1 mg of 1:10,000 (repeat q 3 - 5 min)
7. Consider causes and treat
- Administer epinephrine as soon as feasible
1. CAB's
2. CPR

PLATINUM FINAL EXAM EMTP 3.3 REVIEW 2024 VERSION | ALREADY GRADED A+, Exams of Aviation

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Partial preview of the text

Download PLATINUM FINAL EXAM EMTP 3.3 REVIEW 2024 VERSION | ALREADY GRADED A+ and more Exams Aviation in PDF only on Docsity!

ALREADY GRADED A+

ALREADY GRADED A+

ALREADY GRADED A+

ALREADY GRADED A+

ALREADY GRADED A+

PRIMARY SURVEY/RESUSCITATION:

ALREADY GRADED A+

ALREADY GRADED A+

ALREADY GRADED A+

ALREADY GRADED A+

ALREADY GRADED A+

ALREADY GRADED A+

ALREADY GRADED A+

TION/ATRIAL

ALREADY GRADED A+

UNSTABLE

ALREADY GRADED A+