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All CCEMT-P Flashcards

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1
Q

If CO2 moves OPPOSITE of the pH, this indicates….

A

Respiratory Imbalance

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2
Q

If the HCO3 moves OPPOSITE the pH it indicates…

A

Respiratory Imbalance

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3
Q

If the HCO3 moves in the SAME DIRECTION as the pH it indicates…

A

Metabolic Imbalance

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4
Q

Steps to ABG Interpretation…

A
  1. pH 7.45 alkalosis
  2. PaCO2 >45 acidosis 26 alkalosis
  3. PaO2 normal 80-100mmHg
  4. Anion Gap norm 8-12mEq/L
  5. Seesaw (respiratory) pH & PaCo2
  6. Elevator (metabolic) pH & Hco3
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5
Q

If the CO2 moves in the same direction as the pH it indicates…

A

metabolic imbalance

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6
Q

Increased pH
Decreased PaCO2
No change in HCO3

A

Uncompensated Resp Alkalosis

-hyperventilation

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7
Q

Decreased pH
Increased PaCO2
No change in HCO3

A

Uncompensated Resp Acidosis

-hypoventilation

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8
Q

DIC is….

A

disseminating intravascular coagulation

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9
Q

Causes for elevated D-Dimer…

A

DIC, PE, Sickle Cell, Post surgery,

Vein/artery/coronary thrombosis

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10
Q

Normal D-Dimer levels…

A

less than 1 mcg/mL
or
500 mcg/mL

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11
Q

PTT

A

Partial thromboplastin time (heparin-type)

Norm 22.1-34.1 sec

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12
Q

Thrombocytosis is…

A

the increase of platelets

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13
Q

Thrombocytopenia is…

A

the decrease of platelets

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14
Q

Leukocytosis is…

A

the increase of WBC’s

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15
Q

Leukopenia is…

A

the decrease of WBC’s

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16
Q

Polycythemia/erythrocytosis is…

A

the increase of RBC’s

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17
Q

Anemia is…

A

the decrease o9f RBC’s

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18
Q

Equation to acquire MAP…

A

MAP=mean arterial pressure

2xDiastolic + systolic/3

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19
Q

Septicemia is…

A

the presence of bacteria in the blood

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20
Q

CPK is….

A

Creatnine Phosphokinase- (cardiac biomarker)
Norm 5-35mcg/mL
*levels are increased in 90% of MI

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21
Q

Myoglobin is…

A

released into the bloodstream after injury (including cardiac)
Normal 9-12mcg/dL

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22
Q

BNP is…

A

b-type natriuretic peptide (hormone produced when cardiac ventricles are stretched)
Low value 400

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23
Q

cTnL is…

A

cardiac specific troponin
Normal value <0.2-1.0ng/mL
High value = myocardial injury

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24
Q

Ca++ is….

A

Calcium
Normal 9-11mg/dL
11 is hypercalcemia

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25
K+ is...
Potassium Norm 3.5-5mEq/L 5 is hyperkalemic
26
Na is....
Sodium Norm 135-145mEq/L 145 is hypernatremia
27
INR....
International Normalized Ratio (coagulation test) Normal 1 Norm for ppl on anti-coag's 1.5-2.5
28
PT...
``` Prothombin Time (coumadin-type coagulation test) Normal 11.2-13.2 seconds ```
29
Serum Osmolarity Values...
norm 282-295mOsm | panic values 321
30
Explain the "Rule of Three"...
RBC=5 Hg/Hgb=15 Hct=45
31
Hematocrit is....
measures the volume of RBC in 100mL of blood expressed as a percentage. Norm male- 40-54% Norm female- 36-46%
32
Hg or Hgb
Hemoglobin= measures the globular O2 carrying protein norm male 14-18g/dL norm female 12-16g/dL
33
What do RBC;s do?
- used in O2 transport - normal life is 120 days - diagnose anemia & hydration status
34
Low WBC can be from....
``` Hematopoetic disease Malaria Bone marrow suppression Anemia Viral Infections Stress, Trauma, fever ```
35
Elevated WBC's ccan be from...
``` Acute infection Leukemia Cirrhosis Burns Tissue Necrosis ```
36
Lymphocytes (T-type cells) are produced in the ____ but mature in the ____.
Produced in Bone Marrow, mature in the thymus
37
Lymphocytes (B-type cells) produced AND mature in the ______.
Bone Marrow
38
WBC's function and normal value.....
WBC's locate and kill bacteria and other foreign invaders. This includes "phils" and "cytes" Norm 4,500-10,000
39
CBC tests include...
``` WBC WBC w/differential RBC Hemoglobin & Hematocrit Platelet Count ```
40
PaO2 & SpO2 correlations...
PaO2 equals SpO2 80-100mmHg = 95-100% 60 mmHg = 90% 40 mmHg = 75%
41
PaO2 is the measurement of...
the partial pressure of O2 dissolved in arterial blood
42
SaO2 is the measurement of....
O2 saturation by a co-oximeter
43
PaCo2 is the measurement of....
the partial pressure of CO2 dissolved in blood Normal= 35-45mmHg
44
BE is....
``` Base Excess Norm +3- -3mmol/L mild shock -3 - -5 moderate shock -6 - -9 severe shock > -10 ``` negative base = metabolic acidosis positive base = metabolic alkalosis
45
HCO3 is.....
Bicarbonate | Norm 22-26mEq/L
46
Explain the "Golden Rule" of ABG analysis
- For ever 10mmHg change in CO2, pH goes up .08 opposite. | - For every 10mEq change in HCO3, pH goes .15 opposite
47
Bicarb replacement formula....
kg X base deficit = mEq bicarb needed
48
How can I check the adequacy of ventilation status?
check the PaCo2 (partial pressure of O2 in arterial blood)
49
To check the Acid-Base Status.....
pH (acid balance) PaCO2 (partial pressure of CO2 in art. bld) HCO3 (serum bicarb)
50
To check the oxygenation status....
PaO2 & SaO2
51
H2CO3 is....
Carbonic Acid | result of CO2 + H2O
52
Uric Acid norm....
Norm 2-8mg/dL
53
BUN/Cr Ratio...
-Evaluates renal function Norm 10:1 or less Elevation means renal failure
54
Cr=Creatnine....
- a waste product of protein in urine - aids in diagnosis or renal dysfunction Norm male 0.6-1.4mg/dL Norm female 0.6-1.1mg/dL
55
BUN is....
Blood Urea Nitrogen= metabolic byproduct created from the breakdown of blood, muscle & protein Bun evaluates renal function & hydration Normal 7-21mg/dL 21 dehydrated
56
Zones for transport physiology...
Physiologic Zone- sea level to 10,000ft Physio. Deficit Zone- 10k to 50k ft Space Equivalent Zone- 50k to 250k ft
57
4 Gases to be concerned with regarding air transport...
O2, Co2, Nitrogen and Water
58
Universal Gas Law...
Gas molecules move from area of high concentration to area of lower concentration
59
Boyle's Law...
temp remains constant, volume of a gas is inversely proportional to its pressure (remember "Boyles Law is best of all, cause it compresses gas to small" - increase in altitude, barometric pressure will decrease. - a gas will attempt to expand twice its volume
60
Charles Law...
at a constant pressure, the volume of a gas is related to its temperature (think Charles Cold or Charles Celcius)
61
Ideal Gas Law....
amount of a gas is determined by its pressure, volume and temp
62
Dalton's Law....
total gas pressure is the sum of the individual pressure of all the gases in the mixture
63
O2 correction for Daltons Law...
%FiO2 x P1/P/2 = %FiO2 needed at altitude
64
Henry's Law...
amount of gas in a solution is proportional to the partial pressure of gas in contact with the liquid (decompression sickness)
65
Gay-Lussac's Law....
fixed gas @ fixed volume- pressure is proportional to temp - temp fluctuates with altitude - pressure in O2 tanks will decrease as temp decreases - et cuffs with fluctuate w/temp
66
Graham's Law...
the less dense the gas, the more rapidly it will diffuse through the air
67
4 stages of hypoxia regarding flight...
Indifferent Compensatory Disturbance Critical
68
Self imposed stressors of flight...
``` D-drugs E- exhaustion A- alcohol T- tobacco H- hypoglycemic ```
69
Failure to use such care as a reasonable and prudent practitioner would under similar circumstances is_________.
Negligence
70
________ is the probability that a test will be NEGATIVE in the absence of a disease.
Specificity "rules out"
71
__________ is the probability that a test will be positive in the presence of a disease.
Sensativity "confirms"
72
What are the two primary acid excreting organs?
Lungs and Kidneys
73
Most common cause of Normal Anion Gap metabolic acidosis?
Diarrhea
74
Decreased pH No change in PaCO2 Decreased HCO3
Uncompensated Metabolic Acidosis
75
Increased pH No change in PaCO2 Increased HCO3
Uncompensated Metabolic Alkalosis
76
Figuring room air ABG's....
add PaO2 with the PaCO2 together, should total 110-140
77
SIRS....
Systemic Inflammatory Response Syndrome (must have 2 of the following) - elevated temp - increased respirations - HR >90 - WBC >12,000
78
Three layers of heart....
Epicardium (outer) Myocardium (muscle) Endocardium (smooth inner layer)
79
The right atria is supplied by which artery?
RCA
80
The left atria is supplied by which artery?
Left circumflex
81
4 characteristics of myocardial cells....
Automaticity Excitability Conductivity Contractility
82
Normal Stroke Volume for an average adult?
60-130cc's per beat | the amount of blood ejected by ventricles with each contraction
83
What is the most common complaint in elderly pt's with ACS?
Dyspnea
84
Inflammation of the pericardium causing extra fluid to build up which restricts preload is.......
Pericarditis
85
Beck's triad
Hypotension Elevated Venous pressure Muffled Heart tones JVD
86
2 signs of pericarditis?
Chest pain is primary symptom | Pain is positional and usually worse when laying flat
87
This is the the prominient cause of sudden cardiac death in young adults (middle age)....
Myocarditis- average age is 42. Inflammation of the heart muscle
88
Infection of the heart valves is....
Endocarditis
89
Three categories of AAA...
True- involves all three layers of vessel False- contained by two layers Dissection- separation of the vessel wall which allows blood to leak between the layers of the vessel
90
A ruptured aortic aneurysm exhibits excruciating pain in the ______ and _______.
Lower abdomen and back
91
The causative factor in 62-78% of Aortic Dissection is______.
hypertension
92
HR and BP management for Aortic dissection is?
HR 60-80 | Systolic BP 100-120
93
End stage organ damage from HTN..... (4)
Seizures (HTN encephalopathy) Flash pulmonary edema Acute Renal Failure MI
94
What is "watershed stroke"?
rapid reduction of BP during a hypertensive emergency can result in ischemia or infarction of major organ systems
95
Most common form of heart failure in which fluid and blood backs up into the lungs...
Left-sided heart failure
96
Right-sided heart failure...
- Often occurs with left sided | - Fluid and blood back up into abdomen and legs/feet
97
3 types of Angina
Stable Unstable Variant (Prinzmetal's- occur btwn 12am and 8am)
98
3 factors regarding the severity of an MI
- level of occlusion in artery - length of occlusion time - presence of collateral circulation
99
What is a sign of LVH on a 12 lead ECG?
All R waves run tall and into each other in V1-V6
100
This type of shock is a decreased ability of the heart to pump that usually results from an acute MI
Cardiogenic Shock- when more than 40% of the myocardium becomes damages cardiogenic shock can occur
101
4 possible medications for cardiogenic shock
Dopamine Dobutamine Norepi (Levophed) Epi
102
Adult and pediatric IO's are class____ interventions.
class IIa interventions
103
This is the optimal site for pediatric IO's
proximal tibia
104
These should NOT be used with pressure infusers....
Tunneled catheters and portacaths
105
Types of CVACs
``` Central Venous Access Catheters- Non tunneled (short term) PICC's Tunneled Hickman Broviac Groshong SVAD (portacaths) Subclabvian ```
106
Management of a sluggish CVAC infusion...
Look for kinks Reposition Remove injection cap/look for clot Flush with 20-30mL NS
107
A 500mL bag of NS for an art line should be....
pressurized to 300mmHg using a pressure bag
108
Dampening of art line waveform typically.....
underestimates BP.
109
In the event of a dislodged Art line....
maintain direct pressure for at least 5 minute
110
The 5 stages of the cardiac cycle...
1. Late diastoyle/vent filing 2. Atrial systole 3. Isovolumetric vent contraction 4. Ventricular ejection 5. Isovolumetric vent relaxation
111
Measurements of cardiac performance...
Cardiac Output Cardiac Index SVR (systemic vasc resistance= afterload)
112
Normal Ejection Fraction is....
55-75%
113
An ejection fraction of 40-50% indicates...
damage to the myocardium
114
An ejection fraction of <40% indicates...
heart failure'
115
Equation to determine CO (cardiac output)...
SV x HR
116
equation to determine CI (cardiac index)...
SV x HR/BSA
117
Equation to determine SVR...
MAP-CVP/CO
118
IABP inflation equals....
increased supply
119
IABP deflation equals...
decreased demand
120
IABP placement...
1-2cm below subclavian Proximal to renal and mesenteric arteries will occlude 85-90%of the aorta Balloon is 1 cm distal to the origin of left subclavian
121
Absolute contraindication of IABP...
Aortic valve insufficiency | Dissecting aortic anerysm
122
IABP balloon inflation should be...
30-40cc's of helium
123
Goals of IABP inflation...
``` Increased coronary perfusion Increased systemic perfusion Increased peripheral O2 supply Decrease of SVR Decreased HR ```
124
What does the IABP use for timing and what does it signify?
The dicrotic notch in the EKG which signifies aortic valve closure -can also be triggered by R wave or pacing spike
125
In the event if IABP failure.....
Use a 40-60ml syringe and cycle the balloon every 10 minutes
126
Regarding CPR in progress with an IABP, what needs to be done?
Switch the IABP trigger from EKG to pressure.
127
Indications for ECMO
Hypoxemic Resp failure | Hypercarbic Resp failure
128
No patient on ECMO should be _______ unless a perfusionist is present.
moved
129
This ventricular assist device is a mechanical pump used for blood circulation support.
VAD (ventricular assist device)
130
This is common regarding VAD surgeries...
bleeding, occurs in 30-50% of pt's
131
If the transducer is LOWER than the phlebostatic axis, it will cause....
inaccurately HIGH readings
132
If the transducer is HIGHER than the phlebostatic axis, it will cause...
inaccurately LOW readings
133
When to level the transducer?
whenever a reading is taken insertion after a position change in pt
134
Causes for elevated CVP & RAP...
``` Right sided heart failure Cardiac tamponade Pulmonary HTN Volume overload Postitive pressure ventilation ```
135
Causes for low CVP & RAP...
Volume depletion Vasodilatation Venous Vasodilator Edrogenous System Vasodilator
136
Normal values for PAP (Pulmonary artery pressure)?
Systolic 15-30mmHg | Diastolic 5-15mmHg
137
PAWP, PCWP, PAOP are terms for...
"wedge pressure"
138
The normal value for wedge pressure is...
4-12mmHg
139
what is SvO2?
SvO2 (mixed venous O2 saturation) is the amount of hemoglobin saturated with O2
140
``` Overview of pressures: MAP mean arterial press= CVP central venous press= PAS pulm artery systolic= PAD pulm artery diastolic= PCWP wedge pressure= CO cardiac output= CI cardiac index= ```
``` MAP=70-100mmHg CVP=2-6mmHg PAS=15-30mmHg PAD= 5-15mmHg PCWP= 4-12mmHg CO=4-8L/min CI=2.5-4L/min ```
141
Lymphocytes make....
anitbodies
142
These are used to treat people with Hemophilia A & B, and those with von Willebrands diease...
Platelets
143
Heparin can be reversed by the administration of...
Protamine Sulfate
144
Placement of V1
Right sternal border at the 4th ICS
145
Placement of V2
left sternal border at the 4th ICS
146
Placement of V3
midway between V2 & V4
147
Placement of V4
midclavicular at the 5th ICS
148
Placement of V5
Anterior axillary at 5th ICS
149
Placement of V6
Midaxillary line at the 5th ICS
150
Q wave components:
Physiological- septal wall depolarization, less than .04 seconds, less than 2mm deep Pathological- matured MI, increase in size 20hrs after MI, Present in lead III, consider PE
151
'I See A Lions Paw" is a reference to what?
``` Location of EKG areas: I=inferior: II, III, aVF See=septal: V1, V2 A=anterior: V3, V4 Lions=lateral: I, aVL, V5, V6 Paw=posterior: V1-V6 recip changes ```
152
What leads are focused on when determining axis deviation?
Leads I and aVF
153
Explain the "turn signal theory regarding Bundle Branch Blocks...
In V1, circle the "J" point. Shade the area into the QRS complex. If arrow points up=RBBB If arrow points down=LBBB
154
Q waves are best seen in what two leads?
V2 & V3
155
10 conditions that mimic MI by typical ST changes or Q/QS waves
1. WPW preexcitation 2. IHSS 3. LVH 4. RVH 5. LBBB 6. Pulm Emphysema 7. Left Ant fascicular block 8. Pericarditis 9. Pneumothorax 10. CNS disease
156
The LAD feeds...
Left Anterior Descending: - anterior & anterolateral walls - anterior 2/3 of the septum - left bundle branch
157
The LCX feeds...
Left circumflex: | -posterolateral wall of the left ventricle
158
The RCA feeds...
Right Coronary Artery: - right ventricle - inferior wall - posterior wall - posterior 1/3 of septum
159
Nitro is contraindicated in what type of MI and why?
Inferior MI (right sided) because it will depress the preload - ST depression in I, aVL and anterior leads - ST elevation in II, III and aVF
160
Sharp, peaked "P" waves in leads II, III or aVF indicate...
Right Atrial Enlagement (RAE)
161
Widened or "P" waves with a double hump or "M"shaped appearance indicate....
Left Atrial Enlargement (LAE)
162
What is the SEX-PIN mnemonic for?
Regards Drugs & Electrolytes for cardiac: | Sodium External-Potassium Internal
163
V1-V6 are considered....
Chest leads/precordial leads
164
Leads aVR, aVF, and aVL are considered...
Augmented/limb leads
165
Location of the "J" point
the junction between the QRS and ST segment
166
The duration of the activation and recovery of the ventricle muscle is the _____ on an ECG.
The QTc= normal is 0.41 seconds
167
6 Steps for ECG analysis
1. verify aVR is negative 2. Rate & rhythm 3. Axis 4. Presence of: LBBB, hypertrophy, Aneurysm, pericarditis, Drugs/Electrolytes Early repolarization 5. Ischemia 6. MI patterns
168
A-I approach for chest x-ray...
Airway, Bony thorax, Cardiac silhouette, Diaphragm, Effusion, Fields (lungs), Gatric bubble, Hilum, Invasive lines/devices
169
Where quadrant would pain be located if the cause is appendicitis?
RLQ
170
Where quadrant would pain be located if the cause is diverticulitis?
LLQ
171
Where quadrant would pain be located if the cause is cholecystitis, pancreatitis or PUD?
RUQ
172
Where quadrant would pain be located if the cause is Gastritis, gastric ulcer or splenic rupture?
LUQ
173
The most common cause of pancreatitis is....
Alcohol abuse
174
The primary offender in ALF (acute liver failure) is....
Acetaminophen
175
Migration of pain from the periumbilical area to the RLQ is one of the strongest factors indicating.....
Appendicitis
176
The mortality of this is 90% | Be prepared to give a large fluid bolus and PRBC (packed RBC's)
AAA (abdominal aortic aneurysm
177
Rh factor is important in what demograhic?
women of childbearing age
178
The Universal blood donor is...
O neg
179
The Universal blood recipient is....
AB pos & Rh pos
180
Whole blood components are only given to what patients?
Those in hemorrhagic shock and those who are severely anemic
181
FFP is designated for...
patients with active bleeding or coagulation factor deficiences
182
Cryoprecipitate is designated for....
pt's with Hemophilia A, to supply Factor VIII, fibrinogen and Factor XIII
183
When administrating blood products do not use an IV cath smaller than_______.
20 guage
184
Subtle indications of a transfusion reaction are________ and ________.
Increased HR and increased temperature
185
The volume of air that the lungs can hold with max inspiration is.....
Total Lung Volume=5500-6000mL
186
Volume of air moved in and out of the lungs with each normal breath is.....
Tidal Volume (TV or Vt)=7ml/kg
187
Volume of air maximally inspired above a normal inspiration is....
Ispiratory Reserve Volume (IRV)=3ltrs
188
Volume of air maximally exhaled after a normal exhalation is...
Expiratory Reserve Volume (ERV)=1ltr
189
4 goals of Mechanical Ventilation
- Maintain PaO2 and Pa CO2 - Get acceptable ABG levels - Improve ventilation - Decrease work of breathing
190
Three types of positive pressure ventilators:
Trigger Target or limit Cycle
191
Explain IRV (Inverse Ratio Ventilation)
a vent mode in which inspiratory time is greater than expiratory time (this is the opposite of the norm)
192
Majority of vent patients will be one of these two vent modes...
A/C=assist control | SIMV=synchronized intermittent mandatory ventilation
193
FiO2 is....
FiO2=fraction of inspired air. (expressed as a fraction of one) Initial setting is 1.0=100% and adjusted after ABG is obtained
194
I:E ratio is...
The duration of inspiration compared to the duration of exhalation -typical I:E ratio is 1:2
195
A COPD patient will typically have an I:E ratio of.... And an ARDS pat will normally be....
1: 3 or 1:4 COPD 2: 1 ARDS
196
Signs of O2 toxicity
- V/Q mismatch - diffuse pulmonary infiltrates on Xray - O2 sats falling despite increase FiO2
197
DOPE mnemonic
D- displaced ET O- obstructions P- pneumothorax E- equipment
198
In a right shift on the hemoglobin association curve can be caused by:
Increase of PCO2 Increased temp Increased 2,3-DPG Decreased pH (acidosis)
199
A left shift cause on the hemoglobin association curve can be caused by:
``` Decrease of PCO2 Decreased temp Decreased 2,3-DPG Increased pH (alkalosis) Carbon monoxide poisoning ```
200
Vent settings:
``` TV: 6-8cc/kg Rate: 12-18/min Mode: VC or PRVC FiO2: 1.0 I:E ratio: 1:2, COPD 1:3 or 1:4 ```
201
Common signs of PE...
Dyspnea Pleuritic Chest pain Cough Hemoptysis ( coughing blood)
202
A chest tube designated to remove fluid should be placed...
Midaxillary line, 4/5th ICS (size 20-40Fr)
203
A chest tube designated to remove air should be placed...
Midclavicular line, 2nd ICS (size 16-20Fr)
204
Cric difficulties mnemonic SHORT
``` S- surgery H- hematoma O-obesity R- radiation distortion T- tumor ```
205
LEMON mnemonic:
``` L- look externally E- evaluate M-malampatti O- obstruction N- neck mobility ```
206
The Cormak-Lehane view is...
Grades visualization of vocal cords for ET attempt. Grade 1 is the Ideal view, Grade 4 is the worst view
207
LOAD mnemonic for intubation:
L- lidocaine 1.5mg/kg O- Opioids 3mcg/kg A- atropine (for kids s 0.15mg/kg)
208
A depolarizing neuromuscular blocking agent would be...
Succ's adult dose 1-2mg/kg IVP | kids dose 2mg/kg IVP
209
A non-depolarizing neuromuscular blocking agent would be....
Vecuronium dose 0.1-0.15mg/kg
210
Induction agents would include:
Etomidate 0.3mg/kg | Midazolam 0.2-0.3mg/kg
211
Upper cervical spine injuries carry a high risk for.....
diaphragmatic paralysis (C1 and C2)
212
Massive hemothorax includes what criteria?
1500mL blood loss upon insertion | Coninuted loss of 250mL blood for 3 consecutive hours
213
The pleural cavity of a 70kg man can hold how many liters of blood during a traumatic hemorrhage
4 liters
214
The _____ is the most vascular organ in the body. With aproximately ______ liters of blood passing through it daily.
Spleen, 350 liters
215
The diagnosis of rhabdomyolosis is made based on urinary output and what test?
BUN/Creatnine

CCEMT-P (1 decks)

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