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Final CFRN review > CFRN > Flashcards

CFRN Flashcards

1
Q

3 things that high CO2 indicates

A

acid buildup
low pH
apnea/hypoventilation

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2
Q

what is CO2 regulation a function of

A

minute ventilation (Ve) = Vt x F

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3
Q

base deficit >-4

A

need a blood transfusion

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4
Q

how can you use base deficit to predict need for blood transfusion

A

> -4 needs a blood transfusion

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5
Q

replacement formula for bicarbonate

A

0.1 x base excess x wt in kg = # bicarbonate needed

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6
Q

left shift affinity

A

increased

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7
Q

mneumonic for left shift

A

LEFT = LOW

acidosis, temp, 2,3-DPG, pCO2

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8
Q

mneumonic for right shift

A

RIGHT = RAISE

alkalosis, temp, 2,3-DPG, pCO2

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9
Q

how to tell if ABG is compensated

A

the compensation mnechanism is the opposite of the primary problem

  • R. acidosis is compensated by bicarbonate
  • m. alkalosis is compensated by CO2
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10
Q

partially compensated

A

pH, resp, & metabolic are all out of range

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11
Q

pH, CO2 & bicarbonate are all out of range

A

partially compensated

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12
Q

fully compensated

A

pH is normal

CO2 & bicarbonate are out of range

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13
Q

pH is normal

CO2 & bicarbonate are out of range

A

fully compensated

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14
Q

critical pH for intubation

A

under 7.2

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15
Q

critical CO2 to intubate

A

pCO2 over 55

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16
Q

critical pO2 to intubate

A

under 60

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17
Q

considered lactic acidosis

A

over 4

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18
Q

acid base in hyperthermia

A

m. acidosis

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19
Q

acid base in rhabdo

A

m. acidosis

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20
Q

acid base at high altitudes

A

r. alkalosis

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21
Q

increased minute ventilation

A

increased to blow off CO2 (Vt x F)

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22
Q

every __ in pH, expect the bicarbonate to change by ___ in the ___ direction

A

0.15 pH
10 bicarbonate
same direction

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23
Q

every __ in pH, expect change in K by __ in the ___ direction

A

0.1 pH
K shifts 0.6
opposite direction

  • as pH lowers, K shifts outside the cell giving a falsely elevated K.
  • when correct imbalance by raising pH, K shifts intracellularly so life threatbning low K
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24
Q

every change in ___ ETCO2, expect pH to change by ___ in the ___ direction

A

10 mm hg
0.08
opposite direction

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25
Q

every change in ___ CO2 K shifts ___ in the ___ direction

A

10 CO2
0.5K
same direction

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26
Q

ABG to intubate

A

7.2 pH
CO2 over 55
PaO2 under60

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27
Q

ETT size pediatrics

A

16 + age in years

divided by 4

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28
Q

3-3-2 rule

A

difficult airway predictor
3 in mouth
3 between jaw & hyoid
2 betweenhyoid and thyroid

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29
Q

Mallampati II

A

tonsilar pillars are hidden by tongue

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30
Q

Mallampati III

A

only the base of hte uvula is seen

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31
Q

HEAVEN

A 
difficult airway predictor
hypoxemia under 93%
extremes of size (under 8/obese)
anatomic
vomit/blood/fluid
exsanguination/anemia
neck mobility
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32
Q

failed airway algorithm

A

3 failed attemps,

cric

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33
Q

post intubation management

A

fent
ketamine
versed

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34
Q

SALAD technique

A

suction assisted laryngoscopic airway decontaminatin

*clean airway w/suction, place suction in esophagus, as the intubation tube is passed

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35
Q

RSI dose of paralytic if shock

A

double paralytic b/c low CO slows the onset

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36
Q

RSI pathology consideration when planning the paralytic dose

A

double paralytic if low CO/shock b/c low CO slows the onset

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37
Q

RSI dose of induction agent if in shock

A

1/2 induction dose

less is needed due to depletion of catacholamine stores

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38
Q

RSI dose if low CO/shock

A
  • 1/2 induction dose. less is needed b/c depletion of catecholamine stores
  • double the paralytic bc low CO slows onset
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39
Q

onset/duration of ROc

A

onset under 2 min

duration 30-60 min

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40
Q

reverses Roc

A

Sugammadex

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41
Q

Sugammadex

A

reverses Rocuronium

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42
Q

ABG in Malignant Hyperthermia

A

mixed acidosis
high RR
increased COw

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43
Q

DO NOT give in Malignant Hyperthermia

A

CaCHB b/c problem w/calcium removal from the muscle

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44
Q

contraindications for succ - 7

A 
burns over 24hrs
rhabdo
high K
crush
eye injuries
hx of malignant hyperthermia
any nervous system injury like GB or MG
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45
Q

burn contraindication for succ

A

contraindicated if burns over 24hrs

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46
Q

SE of Succ

A

high K

malignant hypertheria

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47
Q

K in succ

A

high K

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48
Q

4 RSI induction

A

fentanyl
etomidate
ketamine
propofol

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49
Q

RSI & their complications

A

Fentanyl - chest wall rigidity, low bp
etomidate - adrenal suppression
propofol - decrease CPP/MAP so not for head injury/hemodynamically unsatable
Ketamine - preserves larungeal function os airway protection

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50
Q

problem of ETomidate

A

adrenal suppression

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51
Q

RSI w/adrenal suppression

A

Etomidate

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52
Q

RSI that decreasnes CPP/MAP

A

propofol

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53
Q

who should not get ETomidate

A

anyone w/adrenal suppressio

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54
Q

who should not get propofol

A

decreases CPP/MAP so not for head injury/hemodynamically unstable

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55
Q

RSI that decreases CPP/MAP

A

propofol

don’t give to head injury/hemodynamicaly unstable

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56
Q

RSI that shoudl not be given to head injuries

A

NO propofol! b/c decreases CPP/MAP

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57
Q

RSI that should NOT be given to hemodynamically unstable

A

NO propofol! decreases CPP/MAP

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58
Q

important things to remember w/Propofol

A

milk of amnesia
NO analgesiaproperties
decreases CPP/MAP so don’t give to head injury or hemodyanmically unstable

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59
Q

good RSI if in shock

A

ketamine

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60
Q

SE of FLumazenil

A

low bp

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61
Q

position for ramping

A

ear to sternal notch

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62
Q

MacIntosh versus Miller blades

A 
Mac = lifts epiglottis via the vallecula
Miller = direct displacement of the epiglottis
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63
Q

preferred intubation blade for a pediatric

A

Miller = direct displacement of hte epiglottis

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64
Q

bougie size for adults versus kids

A 
adults = 15Fr
kids = 10F
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65
Q

confirm ETT placement -3

A

distal tip 2-3cm above carina
level T3-T4
visualizeing Murphy’s eye where teh clavicle meets

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66
Q

intubation pretreatment

A

LOAD

airway manipulation may cause relfexive sympathetatic response so elevate vials

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67
Q

best RSI for asthmatics

A

Ketamine b/c bronchoD

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68
Q

onset & duration of Ketamine

A 
onset = 40 - 60 seconds
duration = 10-20 minutes
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69
Q

3 properties of KEtamine

A

hypnotic
analgesic
amnesic

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70
Q

common SE w/Etomiate

A

common to vomit when awaken

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71
Q

contraindications to Etomidate

A

don’t use if adrenal suppresision, COPD, shock, Addisons or if hemodynamically unstable

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72
Q

onset & duration of ETomidate

A

15-45 second onset

lasts 3- 12 minutes

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73
Q

dosing of defasciculating rx as RSI pretreatmetn

A

1/10 dose of Roc/Vec prior to SUcc

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74
Q

atropine as RSI pretreatment

A

prevents reflexive bradycarida in under 1yo

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75
Q

lidocaine as RSI pretratment

A

blunts the cough reflex to prevent ICP increase

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76
Q

when do you hear apneurisitic respirations

A

decerebrate posturing

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77
Q

irregular breathing w/pauses & apnea

A

ataxic

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78
Q

BIot’s

A

quick shallow inspiration w/apnea

stroke & pressure on medulla during herniation

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79
Q

respirations in stroke

A

Biot’s

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80
Q

progressively deeper/faster then apnea

A

Cheyne-SToke

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81
Q

respirations in herniation

A

Cheyne-STokes *Cushings Triad

Biots medulla pressure

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82
Q

respirations in posturing

A

Cheyne-STokes - decorticate

apneurisitic - decerebrate

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83
Q

respiratory failure in ARDS

A

hypoxic respiratory failure

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84
Q

respiratory failure in pneumonia

A

hypoxic respiratiory failure

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85
Q

respiratory failure in CHF

A

hypoxic respiratory failure

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86
Q

diagnose hypoxic respiratory failure

A

pO2 under 60

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87
Q

treat hypoxic respiratory failure

A

increase oxygen concentration (FiO2 & PEEP)

*treatment assumes you have adequate tidal volume & rate

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88
Q

dx hypercarbic respiratory failure

A

ETCO2 over 45

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89
Q

ETCO2 over 45

A

hypercarbic respiratory failure

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90
Q

treatment of hypercarbic respiratory failure

A

increase tidal volume (pPLAT)
then rate increase
(double the minute volume (Ve - normal is 4-8L/min)

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91
Q

how to change Vt settings

A

over 8ml/kg can cause barotrauma

*slowly increae and reassess every 15min

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92
Q

Vt setting

A

4-8ml/kg of ideal body weight

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93
Q

pressure versus volume delivery

A

volume = preset volume is consistent. once Vt is reached, exhalation begins

pressure = preset inspiratory pressure. once the pressure is reached, exhalation begins

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94
Q

pPLAT

A

measures the pressure applied during PPV to smal airways/alveoli
*represents the end of inspiratory recoil

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95
Q

when is pPLAT mesured

A

during an inspiratory pause while on m. ventilation

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96
Q

ventilator setting where all aspects of the respiratory cycle are controlled & pt cannot override

A

controlled mandatory ventilationh

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97
Q

best ventilator setting for paralyzed or apneic

A

CMV

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98
Q

peferred ventilation setting for respiratory distress

A

Assist Control

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99
Q

who benefits from Assist Control

A

preferred ventilation setting for respiratory distress

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100
Q

trigger for breaths in Assist Control

A

pt or elapsed time

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101
Q

how does Assist Control work

A

full Vt each time regardless of if it is initiated by pt or the machine. will be supported each time
*irrespective of respiratory effort/drive

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102
Q

anxiety while on Assist Control

A

breath stacking/auto-PEEP

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103
Q

what ventilator setting can cause auto-peep

A

assist control

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104
Q

preferred ventilator setting for ARDS

A

assist control

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105
Q

ventilator supports every breath regardless of it is initiated by pt or the machine

A

Assist COntrol

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106
Q

problem of auto-peep

A

predisposes to barotrauma/hemodynamic compromise
increases WOB/effort to trigger the vnetilato
diminishes the forces generated by the respiratory muscles

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107
Q

how does SIMV work

A

if pt fails to take a breath, the ventilator will do it

*spontaneous breathing in-between breaths set to pre-set intervals

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108
Q

ventilator that allows pt to breathe in-between preset breaths

A

SIMV

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109
Q

ventilator lets pt breathe in-between preset intervals OR ventilator supports every breath but the pt can initiate

A

breathe in-between = SIMV
support each time but pt can initiate= AC
no pt control, all ventilatior = CMV

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110
Q

who benefits from SIMV

A

intact respiratory drive. can take their own breathes between pre-set intervals

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111
Q

best ventilator setting for intact respiratory drive

A

SIMV

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112
Q

how to use pressure support ventilation

A

makes it easier to overcome resistance of hte ET tube. often used during weaning b/c decreases WOB

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113
Q

good ventilator setting to help pt wean

A

pressure support ventilation (PSV)

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114
Q

good ventilator setting to help decrease WOB

A

Pressure Support Ventilation (PSV)

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115
Q

what does the pt determine in PSV

A

pressure support ventilation

*Vt & F

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116
Q

what does PSV do

A

pressure support ventilation

provides pressure during inspiration to decrease pt overall WOB

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117
Q

what does pt need to be able to do in order to use PSV

A

consistent vnetilation effort

pt determiens Vt, F (minute volume)(

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118
Q

pressure alarm if pneumo

A

high

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119
Q

pressure alarm if pt is hypovolemic

A

low

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120
Q

pressure alarm if ARDS

A

high

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121
Q

pt is bucking the ventilator

A

pt-ventilator dysynchrony

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122
Q

problem of pt bucking the ventilator

A

increased oxygen demand, WOB, vitals up. ICP up

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123
Q

how do you know if the pt-ventilator dyssynchrony is occurring

A

curare cleft

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124
Q

curare cleft

A

pt-ventilator dyssynchrony

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125
Q

6 ways to intervene w/pt-ventilator dyssynchrony

A 
manage auto-peep
adjust rate to pt demand
adjust sensitivity/Ve
suction
analgesia/sedation
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126
Q

what settings should you look at if you have sudden acute respiratory deterioration while on m. ventilation

A

PIP (decrease/increase/no change)

pPLAT (no change or increased)

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127
Q

Ventilator Troubleshoot for acute resp deterioration

*PIP is decreased

A

3: air leak, hypo/hypervent

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128
Q

Ventilator Troubleshoot for acute resp deterioration

*no PIP change

A

consider PE

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129
Q

Ventilator Troubleshoot for acute resp deterioration

*PIP increased

A

next you must consider if the pPlat is increased or no change

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130
Q

Ventilator Troubleshoot for acute resp deterioration

  • PIP increased
  • pPLAT increased
A 
abd distension
atelectasis
pneumo
p. edema
atelectasis
pleural efflusion
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131
Q

Ventilator Troubleshoot for acute respiratory deterioration

  • PIP increased
  • pPLAT no change
A

airway obstruction
bronchospasm
ET cuff herniation

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132
Q

RASS scale

A

richmond agitation-sedation scale
+4 = combative
0= alert/calm
-4: deeply sedated

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133
Q

V/Q decreased

A

ventilation not keeping up w/perfusion

resp fail/pneumonia/ARDS/paO2, high pCO2

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134
Q

formula for V/Q

A

alveolar ventilation/CO

~0.8

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135
Q

low V/Q
normal V/Q
high V/Q

A

SAD
low: shunted. alveoli are ventilated but not perfused
A= ventilated and perfused
D= deadspace. alveoli are ventilated but not perfused

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136
Q

example of low V/Q

A

under 0.8
shunt
alveoli are perfused but not vented
ET in mainstem bronchus

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137
Q

V/Q if ET is in the mainstem bronchuis

A

low V/Q
shunted
perfusion w/o ventilation

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138
Q

acid-base in asthma

A

breathing out problem

r. acidosis b/c hypercarbic respiratory failure

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139
Q

CXR in asthma

A

flatted diaphragm

chest cavity is overexpanded due to air trapping

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140
Q

appearence of asthma on ETCO2

A

shark fin

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141
Q

shark fin ETCO2

A

asthma

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142
Q

ventilator intervention for asthma

A

increase I:E ratio to 1:4
b/c this is an exhalation problem
zero peep if possible

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143
Q

I:E setting on ventilator in an asthma attack

A

1:4 b/c this is an exhalation problem

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144
Q

PEEP if asthma attack

A

zero if possible

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145
Q

CXR of COPD

A

flattened diaphragm

chest cavity is expanded form air trapping

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146
Q

problem of COPD

A

breathing out

r. acidosis b/c hypercarbic rspiratory failure

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147
Q

benefit of increased I:E

A

more expiratory time increases CO2 clearence but it does carry a risk of atelectasis
*

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148
Q

CXR of pneumonia

A

patchy infiltrates

lobular consolidation

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149
Q

pathology of ARDS

A

diffuse alveolar injury
increased permeability of the alveolar-capillary barrier
influx of fluid into the alveolar space

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150
Q

CXR of ARDS

A

ground glass appearence
patchy infiltrates
bilateral diffuse infiltrates

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151
Q

CXR shows ground glass appearence

A

ARDS

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152
Q

Swan-Ganz findings in ARDS

A

high PAWP (18-20) b/c the right heart is pumping against the increased resistance in the lung vasculature)

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153
Q

consider if PAWP is high (18-20 range)

A

ARDS/ b/c the right heart is pumping against the increased resistance in the lung vasculature)

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154
Q

ARDS treatment -5

A 
focus on oxygenation
increase PEEP
increase FiO2
lower Vt
increase rate
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155
Q

PEEP setting in ARDS

A

increase

minimum 5

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156
Q

FiO2 setting in ARDS

A

increase

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157
Q

Vt setting in ARDS

A

decrese

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158
Q

F setting in ARDS

A

increase

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159
Q

IBW males

A

50 + 2.3(hight in inches - 60)

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160
Q

IBW females

A

45.5 + 2.3(height in inches -60)

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161
Q

3 criteria for ARDS

A
  1. PaO2/FiO2 under 300
  2. bilateral infiltrates consistent w/p. edema
  3. no clinical evidence of left arterial HTN
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162
Q

what lab indicates ARDS

A

PaO2/FiO2 under 300

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163
Q

pPLAT goal in ARDS

A

under 30

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164
Q

how often should you check pPLAT if on a ventilator for ARDS

A

q4 hrs

after each change in PEEP/Vt

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165
Q

intervention for ARDS if pPLAT is over 30

A

decrease Vt by 1ml/steps

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166
Q

intervention for ARDS if pPLAT is under 25 and Vt under 6ml;kg

A

increase Vt by 1ml/kg until pPlat is over 25 or Vt 6ml/kg

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167
Q

intervention for ARDS if pPLAT is under 30 & breath stacking is occurring

A

increase Vt in 1mk/kg increments to 7 or 8

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168
Q

abnormal labs in Tylenol overdose

A

LFT elevated
low glucose
phosphate abnormal

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169
Q

acid base in ASA overdose

A

r. alkalosis

can progress to m. acidosis

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170
Q

complications of ASA overdose

A

liver & brain damage

hepatic encephalopathy so high ICP

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171
Q

s/s of BB overdose

A 
low bp/hr
conduction delays
low glucose
p. edema
bronchospasms
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172
Q

s/s of CaChB overdose

A

low bp/hr/conduction delays
high glucose
m. acidosis

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173
Q

treat CaChB overdsoe

A

activated charcoal
atropine/pacing
gluconate
IV F

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174
Q

EKG of digoxin overdose

A

slurred upstroke on QRS

risk of high K

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175
Q

overdose that has a slurred upstroke on the QRS

A

digoxin

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176
Q

K in digoxin overdose

A

high

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177
Q

avoid if digoxin overdose

A

avoid electricity like pacing/cardioversion

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178
Q

s/s of DIlantin overdose

A 
SVT
coma
confusion
tremors
DI-like
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179
Q

4 s/s of cocaine overdose

A

CP
HTN
seizures
rhabdo

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180
Q

treat PCP

A

sedatives

no ketamine b/c delirum worsens

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181
Q

treat anticholinergic

A

physostigimine

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182
Q

physostigimine

A

anticholinergic overdose

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183
Q

amyl nitrite
sodium nitrite
sodum thiosulfate

A

cyanide

184
Q

treat hydrocarbon overdose

A

intubation

185
Q

overdose that is treated w/vitamin B6

A

INH

186
Q

treat INH overdose

A

vitamin B6 (pyridoxine)

187
Q

treatment is 2-PAM

A

organosphosphates

188
Q

organophosphate treatment

A

atropine

2-PAM

189
Q

what does tricyclic antidepressant overdose look like

A

anticholinergic

190
Q

EKG of tricyclic antidepressant overdose

A

widened QRS

prolonged QT

191
Q

treatment of tricyclic antidepressnat overdose

A

bicarb to get pH 7.5 - 7.55

vasopressors if low bp

192
Q

ABG of toxic alcohols

A

lethal anion-gap of over 16

193
Q

aka antifreeze

A

ethylene glycol

194
Q

aka windshield wiper fluid

A

methanol

195
Q

complications of hydrocarbon overdsoe

A

chemical pheumoitis
decreased viscosity causes aspiraiton
NO induce vomiting

196
Q

toxidrome of pesticides

A

cholinergic

197
Q

toxidrome is SLUDGE/DUMBELS

A

cholinergic
organophosphates
nerve gases like Vx/Sarin

198
Q

toxidrome of VX/Sarin

A

SLUDGE?DUMBELS

cholinergic

199
Q

examples of cholinergic toxidrome

A

organophosphates

nerve gases like VX, Sarin

200
Q

s/s of nerve agents

A

cholinergic toxidrome
SLUDGE
DUMBBELS
nicotinic stimulation = tachycardia, HTN, fascuculations, paralyskis of respiratory muscles

201
Q

DUMBBELS

A 
diarrhea
urinatino
miosis
bronchorrhea, bronchospasm
emesis
lacrimination
sweating
202
Q

death from organophosphates

A

respriatory muscle paralysis

203
Q

treatment of organophosphate oversoe

A

atropine - decrease airway secreations
pralidoxime
2-PAM to crowbar organophsphate off of ACh
benzos for seizures

204
Q

what type of overdose is atropine

A

anticholinergic

205
Q

what type of overdose is benadryl

A

anticholinergic

206
Q

what type of overdose is antidepressants

A

anticholinergic

207
Q

mad as a hatter….

A

anticholinergic

208
Q

anticholinergic oversoe s/s

A 
mad as a hatter...
blind as a bat -mydriasis
red as a beet
hot as a hare
dry as a bone
209
Q

mad as a hatter…

A

anticholinergic

atropine, benadry, antidepressants

210
Q

level a-line

A

phlebostatic axis

4th ICS midaxillary

211
Q

dicrotic notch

A

represents aortic valve closure

212
Q

represents aortic valve closure

A

dicrotic notch

213
Q

how to determine proper a-line pressure

A

no more/less than 3 ossilations before returning to normal
pressure = determine dampening
many ossillations = too little dampening so the ossilations won’t die and continue to reverbrate
to much prssure = overdampening
too little pressure - underdampening. system is too dynamic

214
Q

air in a-line

A

too much pressure so overdampened

215
Q

air in a-line if the tubing is noncompliant

A

underdampened = too little pressure

216
Q

what does Swan-Ganz measure?

A

pulmonary artery catheter
R heart preload/afterload
L heart preload

217
Q

insertion site of Swan-Ganz

A

central line into subclavian vein

218
Q

PA catheter tips

A

distal tip = pressure
PA port = monitoring/lab samples
proximal = infusions/fluids

219
Q

take wedge pressure

A

distal tip
1.5ml
end of exhalation
not for longer than 15 sec or 3 breaths

220
Q

how to transport a PA catheter

A

deflate balloon to prevent inadvertent wedge with advance

balloon increases at altitude b/c BOyle’s law

221
Q

dicrotic notch on left side of PA catheter waveform

A

RV waveform = tricuspid valve closing

222
Q

dicrotic notch on the right side of the PA catheter waveform

A

PA waveform = pulmonic valve clsoing

223
Q

measure R heart preload

A

CVP 2-6

224
Q

Right ventricular pressure

A

15-25

0-5

225
Q

Pulmonary Artery pressure

A

15-25

8-15

226
Q

PAWP

A

8-12
right heat afterload
left heart preload

227
Q

measure left heart preload

A

PAWP

228
Q

measure right heart afterload

A

PAWP

229
Q

normal coronary perfusion pressure

A

50-60

DBP - PAWP

230
Q

normal CO

A

4-8 L/min

231
Q

catheter whip

A

exaggereated waveforms w/elevated systolic pressure and additional peaks = excessive movement of the catheter within the artery

232
Q

PA catheter has excessive movement within the artery

A

catheter wip

exaggerated waveforms & elevated systolic pressure

233
Q

consider if PA catheter shows elevated systolic pressures

A

catheter whip

excessive movement within the artery

234
Q

how to handle catheter whip

A 
excessive movement of the catheter in teh artery
elevated systolic pressure
1. inflate cuff w/1.5ml of air
2. cough
3. lay o right side
235
Q

2 causes of inadvertent PA catheter wedge

A

balloon migration

Boyle’s law inflation

236
Q

treat inadvertent wedge

A

you’ll see a PAWP waveform

  1. deflate the balloon
  2. cough
  3. reposition pt
  4. withdraw until you see a PA waveform
237
Q

proper waveform to see if using PA catheter

A

PA waveform

238
Q

SVR in hypovolemia

A

increaed

239
Q

indirect estimate of left arterial pressure

A

PCWP = pulmonary capillary wedge pressure

240
Q

CVP in cardiogenic shock

A

decreased

241
Q

PAWP in hypovolemic shock

A

decreased

242
Q

PACP in cardogenic shock

A

increased

243
Q

normal SVR & PVR

A

SVR is 800 -1200

244
Q

CVP in late septic shock

A

decreased

245
Q

SVR in late septic shock

A

increased

246
Q

CO in anaphylaxis

A

increaed

247
Q

`CVP in anaphylaxis

A

decreased

248
Q

PAWP in late anaphylaxis

A

decreased

249
Q

PAWP that indicates IABP

A

PAWP over 18

250
Q

2 effects of IABP

A

increase coronary perfusion

decrease heart workload

251
Q

IABP during systole & diastole

A

deflated

inflated

252
Q

insertion of IABP

A

into femoral vein towards teh heart into descending aorta. above renal arteries/below left subclavian

253
Q

IABP in power failure

A

manually pump every 3-5 minutes to prevent clots

254
Q

early IABP inflation

A

inflation before the aortic valve closes

forces blood back into the LV

255
Q

IABP timing error when blood is forced back into the left ventricle

A

early inflation

256
Q

effects of early IABP inflation

A

harmful
aortic regurgitation
decreased CO
increased SVR

257
Q

shape of early inflantion of IABP

A

U

258
Q

when does late inflation of IABP occur

A

inflation after the aortic valve closes

259
Q

inflation of IABP after the aortic valve closes

A

late inflation

260
Q

shape of late inflation of IABP

A

W

261
Q

problem of late inflation

A

suboptimal augmentation

decreased coronary pressure

262
Q

4 shapes of IABP timing errors

A

early inflate - U
late inflate W
early deflate- deflate
late deflate- widened

263
Q

problems of early deflation

A

decreased negative pressure
deflation of bloon before systole
increaed afterload

264
Q

when does the IABP deflate in early deflation

A

deflate before systole

265
Q

worst IABP timing error

A

late deflation

266
Q

what happens in late deflation of IABP

A

inflation of hte balloon during systole

thus increases afterload & workload

267
Q

Impella

A

continuous flow pump

pulls blood from left ventricle and propels it back into the aorta

268
Q

uses for ECMO

A

external oxygenation w/o PPV messing w/hemodynamics

ARDS, hypoxemia refraxtory to m. ventilation

269
Q

pacing spikes are present but not followed by QRS

A

failure to capture

270
Q

failure to capture

A

pacing spikes are present but not followed by QRS

271
Q

3 causes of failure to capture

A

lead dislodged
low output
lead/pacer failure

272
Q

pacemaker problem if low output

A

failure to capture

273
Q

decreased or absent pacemaker function

A

failure to pace

274
Q

failure to pace

A

decreased or absent pacemaker function

275
Q

pacemaker problem if interference

A

failure to pace

276
Q

pacemaker problem if wire fracture

A

failure to pace

277
Q

causes of failure to pace

A

oversensing
wire frature
interference
lead displacement

278
Q

undersensing

A

pacemaker fails to sense native cardiac activity

279
Q

pacemaker fails to sense native cardiac activity

A

undersensing

280
Q

pacemaker if new LBBB

A

undersensing

281
Q

pacemaker if increased stimulus threshold at the electorde site

A

failure to sense/undersensign

282
Q

pacemaker failure if poor lead contact

A

undersensing/failure to sense

283
Q

causes of failure to sense

A

poor lead contact
new LBBB
increased stimulation threshold at electrode site

284
Q

PVR

A

right heart afterload

285
Q

SVR

A

left heart afterload

286
Q

measures PVR/SVR

A

afterload of right versus left heart

287
Q

measure afterload

A

PVR/SVR

288
Q

3 causes of decreased afterload

A

alkalosis
hypocapnia
vasoD

289
Q

pH & PVR

A

increased PVR = acid

decreasded PVR = alkalosis

290
Q

CO2 & PVR

A

increased PVR in high CO2

291
Q

PVR in ARDS

A

increased over 250

292
Q

PVR in atelectasis

A

increased over 250

293
Q

heart sound heard in hypertrophic cardiomyopathy

A

S4 b/c blood forced back into noncompliant

294
Q

heart if high K

A

decreased conduction

295
Q

inferior MI

A

blocked RCA

II, III, AvL

296
Q

widowmaker

A

LCA block

basically the entire left sid eof hte heart is blocked

297
Q

LAD block

A

anterior
septal
anteriorseptal

298
Q

blocked in anterior MI

A

LAD

299
Q

blocked in septal MI

A

LAD

300
Q

LCX block

A

lateral

posterior

301
Q

troponin times

A

onset 4
peak 14-2
duation 3-5

302
Q

CK-MB times

A

onset 3-6
peak 12-24
duration 2-3

303
Q

V2, V3, V4

A

anterior

LAD

304
Q

anterior MI

A

V2, V3, V4

LAD

305
Q

V1, V2, V3, V4

A

anteriorseptal

306
Q

anteriorseptal MI

A

V1-V4

307
Q

anterior versus anterioseptal

A

anterior V2-V4

anteriorseptal V1-V4

308
Q

I, aVL, V5, V6

A

lateral MI

LCX

309
Q

lateral MI

A

I, aVL, V5, V6

LCX

310
Q

posterior MI

A

V1-V3

dominant R wave in V2

311
Q

V1-V3

dominant R wave in V2

A

posterior MI

312
Q

5 types of MI

A

posterior. V1-V4. LCX
anterior. V2-V4. LAD
inferior. II, III, aVL. RCA
lateral. I, aVL, V5, V6. LCX
septal. V1, V2. LAD

313
Q

BBB

A

STEMI mimic

widened QRS in V1

314
Q

Sgarbossa’s criteria

A

to determine if EKG changes are a variant of LBBB or a STEMI

315
Q

when do you give fibrinoilytics s/p STEMI

A

within 12 hours of MI

316
Q

contraindication fo fibrinolytics s/p STEMI

A

cannot be in cardiogenic shock

317
Q

second line rx for bradycardia

A

dopamine

318
Q

classes antiarrhythmics

A

Na Channel BLockers
BB
K Channel BLockers
CaChB

319
Q

examples of K Channel BLockers

A

Amidarone

Sotalol

320
Q

CaChB

A

vasoDI

negative I/D/C

321
Q

HR & cholinergic

A

decreae HR

322
Q

dobutamine

A

positive inotroph

323
Q

pressors for hypovolemic shock

A

NE

dpoamine

324
Q

pressors for cardiogenic shock

A

dobutamine

milrinone

325
Q

indication for NE

A

hypovolemic shock

326
Q

indication for dopamine

A

hypovolemic shock

327
Q

indication for dobutamine

A

cardiogenic shock

328
Q

indication for milrinone

A

cardiogenic shock

329
Q

action of nitroprusside on preload/afterload

A

dilates so decreases

330
Q

SVR and dopamine

A

increae SVR

331
Q

SVR and nicardipine

A

decrease

332
Q

s/s of endocarditis

A

osler nodes = painful red fingertips

janeway lesions - red lesions on palm/soles

333
Q

EKG of Dressler Syndrome

A

global ST elevation

334
Q

CXR of HF

A

butterfly/Kerly B lines

bilateraldiffuse infiltrates

335
Q

dx mild HTN

A

BNP over 300

336
Q

CXR of aortic dissection

A

widened mediastinum
loss of aortic knob
pleural efflusion

337
Q

Graham’s Law

A

gaseous exchange at the cellular level

  • rate of diffusion directly related to solubility
  • inversely proprotional to square root of density
338
Q

when does TUC change

A

1/2 if rapid decompression

339
Q

gas law that explains soft tissue swelling at altitude

A

Daltons

340
Q

Fick’s Law

A

diffusion of gas

  • partial pressure, area of membrane
  • inversely proprotional to the membrane thickness
341
Q

Graham’s versus Fick’s Law

A

Graham: gas exchange at cellular level
(diffusion rate, solubility, density)

Fick’s
*partial pressure, area, membrane thickness)

342
Q

Henry’s Law

A

solubility of gas r/t pressure above it

increased pressure = increased gas solubility

343
Q

Gay-Lussac’s Lw

A

temp & pressure

344
Q

increased diffusion = decreased molecular weight

A

Graham’s law

lower molecular weight diffuses easier

345
Q

oxygen adjustment calculation for flight

A

FiO2 x P1

divided by P2

346
Q

tooth pain when flying

A

pain on ascent as air trapped in fillings expands

347
Q

ear pain when flyign

A

barotitis

348
Q

face pain when flying

A

ascent & descent

349
Q

mottled skin that looks like a sunburn: skin bends

A

cutis mamorata

350
Q

skin bends s/s

A

cutis mamorata = sunburn

ants on skin

351
Q

transport a diving injury

A

ground

pressurize to 1K

352
Q

obese prior to flight

A

breathe 10L/min nonrebreather for 15min to nitrogen washout

353
Q

anemic hypoxia

A

aka hypemic

hypoxic would be low oxygen

354
Q

anemia in cardiogenic shock

A

stagnant

355
Q

anemia in hemorrhage

A

hypemic

356
Q

4 stages of hypoxia

A

indifferent
compensatory
disturbance
critical

357
Q

stage of hypoxia where you act drunk

A

stage 3- disturbance

358
Q

vitals in g force

A

low bp

359
Q

2 types of peopel who are the most severely affected by high F forces

A

dehydrated

BP meds like BB

360
Q

COBRA

A

protects uninsured pt from being denied hospital care or transfer inappropriately for inability to pay

361
Q

distance from a hospital when you must treat on campus

A

250 yd rule

362
Q

pilot rules

  • training
  • Area orientation
A

2K total hours
1K as pilot in charge
100 at night
5hr area orientation/2 night

363
Q

general operating flight rules

A

Part 91

364
Q

weather minimums under Part 91

A

none

365
Q

flying passengers rules

A

Part 135
14hr day
8hr fly

366
Q

squak code 1200

A

VIsual Flight RUles

367
Q

squak code for gliders

A

1202

368
Q

squak code 1202

A

gliders

369
Q

squak code for hijack

A

7500

370
Q

squak code for communication failure

A

7600

371
Q

squak code 7600

A

communication failure

372
Q

transponder code for emergency

A

7700

373
Q

squak code 7700

A

emergency

374
Q

air movement in autorotation

A

air moves up from below as the helicopter descends

375
Q

pre/post crash sequence

A

pt flat
turn off oxygen
crash position
TFB

376
Q

transmitter frquency of emergency locator

A

121.5 MHz

406

377
Q

who does search and rescue

A

CONUS - civil air patrol

uswaters - coast guard

378
Q

radio frequency blocked by hills/mt

A

VHF

379
Q

limitation of VHF

A

radio frequency blocked by hills/mt

380
Q

distance of VHF

A

long range line of sight 100km

381
Q

air traffic control frequency

A

118-137 VHF

382
Q

range of ultra high frequency

A

300MHz to 1GH

383
Q

limits of ultra high frequency

A

blocked by hills/large bilidings
limited to visual horizon of 30-40 miles
can penetrate foliage/buildings for indoor

384
Q

public safety radio system frequency

A

800 MHz

385
Q

lights on aircraft wings

A

red is port
green is starboard
white is tail

386
Q

ambient temperature of an ambulance

A

68-78 degrees

387
Q

fuel range capacity of an ambulance

A

178 miles

388
Q

ground clearnance of an ambulance

A

6 inches

389
Q

range of audible siren & strobe light

A

> 500ft

390
Q

how often shoudl you check fluid of an ambulance

A

twicea week

391
Q

how often should you check tire pressures of an ambulance

A

twice a week

392
Q

first law of motion

A

body in motion stays…

393
Q

second law of motion

A

mass x accelertion

394
Q

thrid law of motion

A

every action has an equal/opposite reaction

395
Q

red & yellow catagory of STAT

A

immediate

delayed

396
Q

blood loss inj class III shock

A

1500 - 2L

397
Q

blood loss %

A

1 - under 15%
2- 15-30%
3- 30-40%
4. over 40%

398
Q

what 2 values in blood hemorrhage chart are similar

A

RR & % blood loss

399
Q

specific spinal cord fractures

A

C1- JEfferson
C2 = hangman
T12 - chance
burst fraxcture = severely compressed

400
Q

ballance sign

A

dullness in LUQ tha tshifts

401
Q

2 signs in spleen injuries

A

balance - dullness in LUQ that shifts
right flank dull
Kehr’s

402
Q

dullness ot percussion in LUQ

A

Ballance sign

403
Q

REBOA

A

resuscitative endovascualr balloon occlusion of hte aorta

*internal tourniquet to occlude blodo flow from the aorta until go to OR

404
Q

blood in labia/scrotum

A

COopernail’s sign

suspect pelvic fracture

405
Q

when do you suspect tension pneumo if on m. ventilation

A

sudden PIP/pPLAT increase

406
Q

scaphoid abdomen on xcary

A

diaphragmic hernia

407
Q

dxray of diaphragmic hernia

A

scaphoid hernia

408
Q

Kussmaul’s sign

A

rise in venous pressure on inspiration

cardiac tamponade

409
Q

when do you see paradoxial pusle

A

cardia tamonade

410
Q

5 s/s in cardiac tamponade

A 
pulsus paradous
tachyardia
Beck's Triad
Kussmaul's sign
electrical alternans
411
Q

Beck’s Triad

A

in cardiac tamponade
JVD
narrow p[ulse pressure
muffled heart sounds

412
Q

electrical alternans

A

EKG of cardiac tamponade

heat gets closer to and further away as it moves around inside the sac of fluid

413
Q

pulmonary edema in blood transfusions

A

TRALI

414
Q

treatment of TRALI

A

reaction to leukocyte antibodies
up to 6hr post transfusion
causes acute pulmonary edema

415
Q

treat TACO

A

circulatory ocverload so give Lasix

416
Q

uses of cryoprecipitate

A

hemophilia
DIC in trauma
von willebrand

417
Q

treat von willebrand

A

cryo

418
Q

treat hemophilia

A

cryo

419
Q

what is cryo

A

created from FFP

conains factors

420
Q

created from FFP

A

cryo

421
Q

most common rd for trauma related DIC

A

cryo

422
Q

acceptance of FFP

A

requires ABO compatibility but not Rh matching

423
Q

needs ABO compatibility but not Rh matchin

A

FFP

424
Q

reverses warfarin

A

FFP

425
Q

uses for FFP

A

coagulation
reverse warfarin
make cryo

426
Q

what is FFP

A

PRBC with RBC suspended

427
Q

T&C for plt

A

not needed

428
Q

T&C for FFP

A

ABO compatible but not Rh match

429
Q

blood in anteior chamber of eye

A

hyphema

430
Q

s/s of tracheobrachial disruption

A

occurs within 1.5 of carina
SC emphysema
Hamman’s Crunch

431
Q

EKG of Rhabdo

A

peaked T

prolonged QT

432
Q

landmarks for femoral line insertion

A

lateral to medial = NAVEL

nerve, artery, vein, lymph nose

433
Q

rules for pilots wearing oxygen

A

10-12K if unpressureized over 30 minutes

always over 12K

434
Q

rules for passengers weraing oxygen

A

12-14K minimum crew wars if over 30min

all over 15

435
Q

rate at which temperature and altitude change

A

lapse rate

3.5F per 1K ft

436
Q

pain in GI w/altitude

A 
ascend = pain worse
descend = pain better
437
Q

4 stages of hypoxia

A

indifferent = up to 10K
compensatory = 10-15
disturbance= 15-20K
critical - over 20K

438
Q

TUC 18K ft

A

20/30min

10-15 if rapid decompression

439
Q

TUC i25K ft

A

3-5min

440
Q

TUC 30K ft

A

1-2 minutes

441
Q

TUC ar 35Kft

A

30-60sec

442
Q

decibels of a single engine cockpit

A

70-90 db

443
Q

F if on a ventilator for ARDS

A

18-22

444
Q

PEEP if on a ventilator for ARDFS

A

over 10

445
Q

Vt if ARDS

A

low

4ml/kg

446
Q

ventilator settings for ARDS

A

peep over 10
high FIO2
low Vt like 4ml/kg
increase F to 18-22

447
Q

Swan-Ganz of ARDS

A 
high PAWP (18-20)
pressure is higher than normal b/c right heart is pumping against increased resistance in teh lung vasculature
448
Q

CXR of ARDS

A

ground glass
patchy infiltates
bilaterlal diffuse infiltrates

449
Q

rule of 9’s legs

A

9%

450
Q

rule of 9’s chest/abdomen

A

each are 9%

451
Q

rule of 9’s head

A

4.5%

452
Q

rule of 9;s arms

A

4.5%

453
Q

burn transfer center critieria for parital thickness

A

transfer if partial thickness is over 10% TBSA

454
Q

gas law that explains hypoxic hypoxia

A

Graham’s

455
Q

R on T phemenon

A 
A PVC close to or at the same time as T so R & T at the same time.
Ventricular repolarization (T) at the same time as the PVC so the cells assume thr ventricular rhythm as the dominant one which can lead to Hemodynamic instability
456
Q

R on T phemenon

A 
A PVC close to or at the same time as T so R & T at the same time.
Ventricular repolarization (T) at the same time as the PVC so the cells assume thr ventricular rhythm as the dominant one which can lead to Hemodynamic instability
457
Q

3 causes of PVC

A

Low K, heart disease, hypoxia

Final CFRN review (1 decks)

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