2021 End of Year Exam Flashcards
What are the 2 main goals of IABP therapy?
Decrease the workload of the LV and reperfuse the coronary arteries.
Early IABP balloon inflation increases:
oxygen demand and decreases oxygen supply
Which of these is the most dangerous IABP timing error?
Early inflation
The IABP balloon should deflate at the:
very end of diastole
The Impella device has a purge fluid to:
prevent blood from entering the motor
If CPR is required when using an Impella device:
Decrease to P-2 and begin chest compressions
You notice the Impella purge flow rate increased from 12.8ml/hr to 13.1ml/hr, what is an appropriate action?
This is a normal automatic adjustment to the purge system.
What should be the highest point on your IABP arterial waveform?
Diastolic Augmentation Pressure.
This was marked as the correct answer, but doesn’t seem correct
How often do you need to zero an IABP with fiberoptic technology?
The fiberoptic recalibrates itself automatically.
Your patient has an Impella CP in place and you notice multiple suction alarms, what action should you take first?
Decrease the P level by 1 to release suction event and further assess patient.
Moderate hyperkalemia with a level of approximately 7mEq/L will show what type of tracing on an ECG?
Peaked T waves
What does an ECG record?
The electrical activity of the heart
According to the “turn signal method”, a RBBB has a QRS complex in V1 that is predominantly:
upright/positive
What causes the QRS to wide in a LBBB?
Delayed ventricular conduction
The electrode for lead V6 is placed in 5th intercostal space at the:
mid-axillary line
The chest leads are also called the:
precordial leads
How many electrodes are used to obtain a 12 lead?
10
Extreme axis deviation is cause when an electrical impulse originates:
in the ventricles
The vector of an electrical impulse typically travels in what direction?
down and to the left
The PR interval measures:
the time an electrical impulse is held at the AV node.
Two important questions to ask when evaluating a pediatric patient with asthma are
Prior admission to the ICU and prior history of intubation
Infants are ___ able to ____ their tidal volume, and therefore are able to compensate by ____ their respiratory rate.
Less, increase, increasing
What are the differences of the pediatric airway?
Floppy, U shape, Longer
In the asthmatic pediatric patient that is intubated and placed on the vent, the I:E ratio should be adjusted to
1:4 - 1:8
The number one cause that exacerbates Asthma in pediatrics is
Upper respiratory tract infection
Where is a foreign body that is aspirated by a pediatric patient most frequently found?
Right mainstem bronchus
Which of the following formulas is the correct way to calculate ideal body weight for a pediatric patient?
(Age x 3) + 7
Which of the formulas listed below should be utilized to determine minute volume including dead space for a pediatric patient?
Ideal body weight x 120ml
Auto-PEEP is best defined by which of the following statements?
The combined pressure of intrinsic PEEP and programmed PEEP.
Which of the following actions listed below will occur when adequate expiratory times are included in your pediatric ventilator management strategy?
Prevention of breath stacking and auto-PEEP
You have a trauma patient and are preparing to administer TXA. You are carrying a vial containing 1000mg in 10ml. Your patient care guidelines recommend you administer a loading dose of 1gm over 10minutes after you mix it in a 100ml bag of NSS. How many ml/hr will the pump infuse?
600ml/hr
You are treating a patient suffering from a prolonged seizure. Your patient care guideline recommends Versed be given at 2.5mg slow IV push. Your drug bag contains a vial of Versed with 10mg in 2ml. How many mls will you push?
0.5ml
You have just successfully defibrillated your patient from ventricular fibrillation following the administration of one dose of Lidocaine. Your patient care guideline recommends a Lidocaine drip at 2mg/min. The patient weighs approximately 190 lbs. Your drug bag has one pre-filled syringe of Lidocaine at 2gm in 10ml, a 500ml bag of NSS. How many ml/hr will the drug infuse?
30ml/hr
You are transporting a patient for cardiac catheterization. Enroute the patient begins complaining of increased chest pain. Your patient care guideline recommends an increase to the NTG infusion from 10mcg/min to 15mcg/min. Your patient weighs 90kg, the NTG is mixed 50mg in 500ml of NaCl and has been infusing at 6ml/hr. What is the new rate for the IV pump in ml/hr?
9ml/hr
Your patient is hypotensive and you have turned off the NTG drip. You receive an order from your medical command to begin a Dopamine infusion. She orders yout o begin the infusion at 10mcg/kg/min, increasing by 2mcg/min until the patient’s BP improves. You have a premixed bag of Dopamine, mixed 1600mcg/ml. How many ml/hr will you start the infusion?
34 ml/hr
The maintenance dose of TXA follows the loading dose. Your patient care guidelines recommend infusing 1gm over 8 hours after mixing your TXA supplied as 1000mg in 10ml in 250ml of NSS. How many ml/hr will the pump set to?
31.25 ml/hr
You are preparing to intubate your patient. The patient weighs approximately 180 lbs. Your patient care guidelines call for the medications listed below along with the concentrations you have in your drg bag: Etomidate: 0.3mg/kg IVP - Supplied as a vial containing 40mg in 20ml. Rocuronium: 1.5mg/kg IVP - Supplied as a vial containing 100mg in 10ml. How many mls of each drug will you be administering?
Etomidate = 12.5ml / Roc = 12.3ml
Your patient is experiencing septic shock. You have been ordered to start an Epi infusion at 2mcg/min. Your patient weighs 155 lbs. You have mixed the medication in preparation for the infusion by placing 1mg of Epi in a 250cc bag of NSS. How many ml/hr will the pump set to?
30ml/hr
Medical command has ordered you to start a Nipride infusion on a severely hypertensive patient. The patient weighs 170lbs. The order is to start Nipride at 0.5mcg/kg/min, titrating according to your patient care guidelines until a SBP less than 130 mmHg is achieved. You obtain the medication from the hospital, and they give you a vial containing 50mg in 2ml. You have a 250ml bag of D5W on hand. How many ml/hr will you start the infusion?
12 ml/hr
You are treating a patient complaining of chest pain. The patient weighs approximately 170 pounds and has had three (3) doses of sublingual nitroglycerin. Your patient care guidelines allows you to proceed with Morphine Sulfate 4mg IV push. In your drug bag is a pre-filled syringe containing 10mg Morphine Sulfate in 1ml. How many ml’s will you administer?
0.4ml
The “V” in HEAVEN mneumonic stands for:
vomit
Continued resuscitation after intubation includes all of the following actions, except:
cooling the patient to 30 degrees Celsius
Which of the following is not an airway assessment mnemonic?
MUDPILES
Which of the following patients qualifies for CRASH airway management?
A septic patient that is unresponsive with agonal respirations at 6 breaths per minute, a BP of 75/40, and a pulse ox of 80%.
Crew resource management is:
an important means of communication for all phases of transport and patient care
The H in the SHORT difficult cricothyrotomy mnemonic stands for
hematoma
Where is a foreign body that is aspirated by a ped patient most frequently found?
right mainstem bronchus
Which size BVM should be used to ventilate a needle cric?
Ped BVM
All of the following will increase your first pass intubation success rate, except:
having poor CRM with your partner
The 3 reasons CRASH patients arrest peri-intubation are:
hypoxia, hemodynamic instability, and low pH
All of the following are true in the care of the bariatric patient except
you cannot do NIPPV on an 8 year old obese patient
What is 1 way the transport provider can decrease plateau pressures in the bariatric patient?
Decreasing the tidal volume
Transport considerations of the obese patient include the
ability to maintain desired position of patient
Intubation considerations for the bariatric patient include all of the following except:
narrow posterior airway
The following are all bariatric physiological changes except
functional residual capacity is increased
According to the time to desaturation curve chart, which of the following patients would be the most likely to desaturate fastest?
127 kg and 5’8”
What is the desired tidal volume range for a patient with a total body weight of 180kg that is 6’3” tall?
480 - 640 ml
During NIPPV, if the patient asks for “more air” or are air hungry, the crew member should _____ on the revel?
decrease the rise time
Which of the following formulas is the correct way to calculate ideal body weight for a pediatric patient?
(Age x 3) + 7
Which of the formulas listed below should be utilized to determine minute volume including dead space for a pediatric patient?
Ideal body weight x 120ml
Tracheostomies:
are placed through the tracheal ring, usually between the 2nd and 3rd rings.
What procedure prevents a transport crew from being able to perform an oral endotracheal intubation on a patient?
laryngectomy
A tracheostomy is considered established how many days post insertion?
7 days
Which of the following is not a complication of a tracheostomy?
Dental trauma
When monitoring an extra-ventricular drain to obtain an intra-cranial pressure, where should the transducer be positioned to properly zero the pressure line?
tragus of ear
Which of the following assessment finding for a patient with an extra-ventricular drain does not require the transport team to contact medical control to notify the receiving neurosurgeon?
The transport crew notices that there has not been any drainage for 30 minutes and the patient’s intra-cranial pressures have remained unchanged.
Having the extra-ventricular drain positioned too high will provide a:
false low intra-cranial pressure reading and cause insufficient draining of CSF
A high PA pressure can be attributed to:
pulmonary hypertension
A high CVP could be indicative of all the following, except:
vasodilation
A normal CVP is:
2-6 mmHg
What is the desired tidal volume range for a ped patient with an ideal body weight of 22kg?
88ml - 176ml
Your patient care guidelines recommend a Fentanyl dosed of 1mcg/kg for pediatric patients. What is the volume of Fentanyl (100mcg/2ml) that you should administer to your 22kg patient?
0.44ml
Which of the following formulas is the correct way to calculate ideal body weight for a ped patient?
(Age x 3) + 7
Which of the formulas listed below should be utilized to determine minute volume including dead space for a pediatric patient?
Ideal body weight x 120ml
Which of the calculations listed below is the correct weight based calculation for pediatric blood product administration?
10ml/kg
Generally accepted age to perform a needle cric?
<10 years old
What formula is used to calculate pediatric uncuffed ETT size?
(age/4) + 3.5
What formula is used to calculate the lowest acceptable systolic blood pressure in the pediatric patient?
70 + (age in years x2)
Which of the following would not be used for continued sedation for post-intubation care?
Rocuronium
What medication class could be used to help treat or prevent an emergence reaction?
Benzodiazepines
What is the adult dose for a Ketamine infusion?
1-4 mg/kg/hr
The physiological response of the body to decreased pain will be seen as:
decreased heart rate and slight decrease in BP
All the following are possible side effects of Ketamine except:
decreased salivation
When providing pain therapy for a patient, what is the correct analgesic dose for Ketamine?
0.25 - 0.5 mg/kg IVP
Side effects of Versed include all of the following except:
hypertension
What is the recommended maximum dose for a Cardene infusion?
15 mg/hr
Besides hypersensitivity, what condition is an absolute contraindication for Cardene?
Advanced aortic stenosis
Levophed works predominantly as what type of agonist?
Alpha 1
Preeclampsia is a triad of which of the following?
Proteinuria, hypertension, edema of face and hands
The score for normal deep tendon reflex is:
+2
The following medication is not used to stop preterm labor:
Pitocin
The transport team recognizes that DIC is a common complication of:
abruptio placenta
Side effects of brethine (terbutaline) administration in the OB patient include:
tachycardia and anxiety
You are transporting a 32 week gravida 2 para 1 patient who was involved in a MVC at a moderate rate of speed. She is complaining of severe abdominal pain. You note vaginal bleeding that is dark in nature. What condition do you suspect?
Abruptio placentae
Your 26 year old preterm labor patient is experiencing contractions approx every 10 min. You would expect to administer which of the following?
Brethine 0.25mg SQ
Therapeutic mag sulfate levels to prevent seizures range from 4-8 mEq/L. What assessment finding indicates mag sulfate toxicity?
absent deep tendon reflexes
When should you inspect a prolapsed cord for a pulse:
initially and during a contraction
HELLP syndrome is defined by all of the following, except:
preeclampsia
Blood loss can be evaluated indirectly by assessing all of the following, except:
breath sounds
All of the following are causes of DIC in the OB patient except:
All are causes of DIC in the OB patient
What 2 ion values should be monitored while transfusing blood?
calcium and potassium
Which of the following is not a sign/symptom of preeclampsia?
gradual hypotension
DIC is a pathologic disruption in hemostasis. There is a systemic activation of blood coagulation, which results in all of the following, except:
abundant platelets
When giving an OB patient blood, what is the ratio and blood type of PRBCs, plasma, and platelets if the patient is not crossed matched?
1:1:1 O negative
DIC stands for:
disseminated intravascular coagulation
Postpartum hemorrhage is characterized by cumulative uterine blood loss of:
> 1000 ml
The occurrence of what symptom changes preeclampsia to eclampsia?
seizure
Common signs and symptoms of Acetylsalicylic Acid overdose are:
Severe anion gap metabolic acidosis, respiratory alkalosis, tinnitus
What amount of ingestion of Tylenol is considered to be toxic?
150mg/kg
Select the reversal agent for lethal digitalis overdose.
Digoxin fab antibodies
Common anticholinergics Signs and symptoms are:
delirium, fever, mydriasis, dry mucous membranes, flushing
The treatment utilizing administration of Fomepizole is used in what type of overdose?
ethylene glycol
Methanol metabolizes in the body into:
formic acid
