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CCP > Term 1 > Flashcards

Term 1 Flashcards

1
Q

Weight limit for folding and non-folding #9

A

Folding: 350lbs

Non-folding: 500lbs

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2
Q

4 types of hypoxia

A

Hypemic (anemia, Fe deficiency, CKI)
Hypoxic (low FiO2)
Stagnant (g-force, cardiogenic shock)
Histotoxic (alcohol, cyanide, sepsis)

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3
Q

Guy Lussac’s Law

A

Volume remains the same. Temperature will affect changes in pressure and vice versa.

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4
Q

Could These Guys Possibly Be Virgins Mnemonic:

A 
Charle's Law
Temperature
Guy Lussac's Law
Pressure
Boyle's Law
Volume
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5
Q

CVP Waveform

A 
A - Atrial contraction
Z - Ventricular depolarization
C - Tricuspid valve elevates into RA
X - Ventricular relaxation
V - Passive filling of RA
Y - Tricuspid valve opens
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6
Q

Bladder pressure monitoring

A
  • Patient supine
  • 20 to 25cc of warm saline (1mL/kg to max 25cc), wait 60 seconds so detrusor muscles relax
  • Clamp Foley to keep saline in bladder
  • Transducer at Iliac crest
  • Measure during exhalation
  • Normal IAP is 5 to 7mm/Hg. Abdominal HTN at > 12mm/Hg
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7
Q

Contradictions for placing an arterial line

A
  • Failed Allan’s test
  • Reynaud’s syndrome
  • Buerger’s disease
  • Trauma/infection
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8
Q

CVP values

A
  • Measure from distal (brown) port
  • Normal range is 2 to 6mm/Hg
  • Normal range in mechanically ventilated patients: 8-12mm/Hg
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9
Q

Troubleshooting an arterial line

A
  • Ensure enough pressure (300mm/Hg) on bag
  • Ensure enough fluid in bag
  • Check for air in the line
  • Make sure transducer is in place
  • Open to patient with vent closed
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10
Q

Calculate abdominal perfusion pressure and state normal value

A

APP = MAP - IAP (bladder pressure)

Target APP of 50 to 60mm/Hg

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11
Q

Transducer placement for ICP monitoring

A

Tragus of the ear.

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12
Q

What is specificity?

A
  • Rules out false positives
  • The ability of the test to correctly identify those who have a disease.
  • If the test is 90% specific for HIV and you test someone without HIV, then the test will be right 90% of the time.
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13
Q

What is sensitivity?

A
  • The ability of the test to correctly identify those who do not have the disease.
  • Rules in true positives
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14
Q

What is normal range?

A

Greater than 95th percentile

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15
Q

What’s included in a CBC?

A
  • WBC
  • Hct
  • PLT
  • Hgb
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16
Q

GOLDMARK for elevated anion gap acidosis

A 
Glycols
Oxoproline
L-lactate
D-lactate
Methanol
ASA
Renal failure
Ketones
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17
Q

5 steps to interpreting an ABG

A
  • acidemia or alkalemia
  • respiratory or metabolic
  • calculate the anion gap
  • what is the compensatory mechanism
  • is there a superimposition
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18
Q

ABG Compensatory Factors

A

Metabolic acidosis - 1:1
Metabolic alkalosis - 1:0.7
Respiratory alkalosis - 1:05
Respiratory acidosis - 1:0.3

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19
Q

Calculate anion gap and state normal value

A

AG = Na+ - (Cl- + HCO3-)
Add 3 to every deficit of ten from normal albumin levels (40)
Normal range should be 8-12

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20
Q

Positive RASS scores

A

+4 combative (danger to staff)
+3 very agitated (pulls at ETT)
+2 agitated (ventilator dyssynchrony)
+1 restless (fidgety, non-purposeful movements)

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21
Q

Negative RASS scores

A
  • 1 drowsy (wakes to voice, eye contact > 10 seconds)
  • 2 lightly sedated (wakes to voice, eye contact < 10 seconds)
  • 3 moderately sedated (movement/eye opening to voice, no contact)
  • 4 deeply sedated (no response to voice, opens eyes to pain)
  • 5 non-rousable (no response to verbal or physical stimuli)
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22
Q

3 Phases of anesthesia

A

Induction
Maintenance
Emergence

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23
Q

4 Principles of anesthesia

A

Amnesia
Analgesia
Areflexia
Autonomic stability

24
Q

Liver function tests vs liver enzyme tests

A

LFTs (PTT, aPTT, glucose, INR, bilirubin, albumin)
-measures functionality of liver if diseased

Pancreatic enzymes (amylase, lipase)
Transanymase enzymes (ALT, AST)
Cholestatic enzymes (ALP, GGT)
-measures if a healthy liver has been damaged.
*If the liver is in chronic failure, then there might not be enough healthy liver cells to release enzymes, in which case you’ll see normal enzyme levels despite a fucked up liver.
*Really only care when the transanymase enzymes are in the 1000s.

25
Q

Tell me a little something about lactic acidosis

A

Type A - Hypoperfusion/Hypoxia
Type B - Other
Diabetes (metformin, DKA hypovolemia, D-lactate), alcoholism (liver dysfunction, mitochondrial dysfunction), HIV, malignancy, Beta agonists, congenital mitochondrial dysfunction, drugs (Propofol)

*D lactate - short bowel syndrome

26
Q

Oxygen delivery equation

A

DO2 = CO x CaO2

Or…

DO2 = [CO] x [(Hgb x 1.36 x SpO2) + (PaO2 x 0.003)]

27
Q

Steps for inserting a Foley

A
  • Prepare equipment (foley, lube, tray, bag) & prep sterile field.
  • Position drapes
  • Lube catheter
  • Cleanse labia/head of penis
  • Insert catheter until urine flows
  • Connect catheter to collection bag and secure x 3
28
Q

Complications of abdominal compartment syndrome

A
  • Compression of vena cava and reduction in preload/CO.
  • Restricted diaphragm impedes ventilation.
  • Lung compression causes atelectasis, reducing surface area/shunt.
  • Renal artery compression causes AKI.
  • Bowel ischemia causes bacterial translocation, worsens vasodilation.
29
Q

Field interventions for abdominal compartment syndrome

A
  • Adequate sedation for ventilation.
  • High PEEP
  • Pressors with no fluid bolus required, even if IVC is reduced.
  • Diuresis
  • Needle abdocentesis?
30
Q

Cardinal signs of systolic failure

A
  • Decreased contractility and reduced EF (<40%).
  • Large, dilated ventricle
  • Increased preload, congestion, pulmonary edema
  • Increased afterload
  • S3
31
Q

Cardinal signs of diastolic failure

A
  • Stiff, non-compliant ventricle
  • Preserved ejection fraction
  • Leaves elevated pressures in left atrium
  • S4
32
Q

Target MAP for kidney protection

A

> 65mm/Hg

33
Q

N. Hgb levels

A

Men: 135-175
Women: 120-160

34
Q

Reasons for non-anion gap metabolic acidosis

A
  • GI losses
  • Renal tubular acidosis
  • Hyperchloremia
35
Q

PYNG land marking

A

2 cm below the sternal notch

Apply patch first and center PYNG

36
Q

What to expect in the event of a rapid depressurization

A
  • Cyclonic winds
  • Freezing temperatures/hypothermia
  • Darkness
  • Hypoxia with rapid DLOC (reversal of oxygen gradient)
  • Decompression sickness (pain, nausea)
37
Q

Type II Respiratory Failure

A

Failure to ventilate appropriately

  • Neuromuscular disease (Guillain Barre, Mysasthenia gravis, muscular dystrophy), SCI, MSK trauma, CNS depression, anesthesia, post-arrest, brain injury, airway obstruction, drug overdose, asthma, COPD exacerbation.
  • Decreased ventilation causes increased PaCO2 and decreased pH.
38
Q

Pros and cons for Arterial line vs /NIBP

A
  • Requires maintenance (pressure in bag, no air in line, fluid in bag)
  • Must be positioned at phlebostatic axis and stay there.
  • Must be zeroed and pass square waveform test?
  • It’s invasive and can hurt
  • Better for MAP
  • Requires right cuff size
  • Dysrhythmias make it innaccurate
  • Better for SBP
39
Q

How many oscillations should be seen following a square waveform test?

A

Two

  • Less than 2: over damped
  • More than 2: under damped
40
Q

The three main determinants of oxygen delivery are:

A
  1. Effectiveness of the pump (cardiac output)
  2. The capacity of the blood to transport oxygen (Hgb levels)
  3. The amount of of oxygen in the blood when it leaves the lungs (SaO2)
41
Q

Three factors that influence arterial oxygen saturation are:

A
  1. Pressure gradient of oxygen in the lungs (FiO2)
  2. Ventilation
  3. Effectiveness of gas exchange at the alveolar-capillary membrane (surface area, a-c thickness, diffusion coefficient)
42
Q

How warm does the fluid warmer warm IV solution?

A

40 degrees Celsius

43
Q

What is the minimum flow rate on our Alaris pumps?

A

0.1mL/hr

44
Q

How wide of a gap do you need between the two ends for a pelvic binder to be effective?

A

6”

45
Q

Fluid side pump alarm

A

Valve not open (propofol, TNG)
Improperly spiked
Kinked/compressed tubing

46
Q

How many times can you hit the “Clear Air” button on the Alaris pump before it locks out?

A

6

47
Q

With the hierarchy of research, what is considered the best evidence?

A
  1. Systematic reviews with meta-analyses of RCTs with definitive results.
  2. RCTs with definitive results
  3. RCTs with non definitive results
  4. Cohort studies
    …
  5. Case reports
48
Q

What does PICO stand for?

A

P - Patient, population, problem
I - Intervention
C - Comparison (what is the main alternative?)
O - Outcome (what can I affect?)

49
Q

Define, “Incompetent Adult”

A

A vulnerable adult who is 19 years or older who receives assistance in performing the normal activities of daily living or who is unable to provide for their own protection.

50
Q

What is an RCT?

A

Randomized controlled trial is a study in which people are allocated at random to receive one of several clinical interventions. One of these interventions is the standard of comparison.

51
Q

What are our controlled substances?

A

BCEHS:
Benzodiazepines, morphine, fentanyl, pethidine, ketamine, propofol

GoC:
Benzodiazepines, fentanyl, morphine, ketamine

52
Q

What federal law governs our possession, transportation and administration of controlled substances?

A

Controlled Drugs and Substances Act

53
Q

Flow rates (1L infusion) for various catheters:

A

14ga: 90 seconds
16ga: 2min, 20sec
18ga: 4min, 23sec
20ga: 6min, 47sec

54
Q

Methods of safely transporting psych patients…

A
  • Perform BARSTOOL (mental, behavioural, emotional states for past, present and future)
  • Gain consent to start an IV and physically/chemically restrain (make sure they use bathroom first)
  • All the seat belts, including shoulder straps
  • Put the tray on as added barrier
  • Rear most stretcher, away from pilots
  • Preflight Gravol and Ativan
  • Easily accessible IV
  • Propofol for rapid on/off
  • Airway equipment at hand
  • Sux and a BVM on standby
  • EEG monitoring
55
Q

5 reasons to snorkel someone

A
  1. Oxygenation
  2. Ventilation
  3. Protection
  4. Progression
  5. Uncompensated Shock
56
Q

Define shock index

A

HR/SBP

Normal = SI < 0.7

SI > 1.0 = Specific indicator of hyperlactemia and 28 day mortality.

SI > 0.8 = Predicts intubation crash.Resuscitate first!

CCP (18 decks)

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