Overview Flashcards
(197 cards)
1
Q
What is Hypoxic Hypoxia?
A
Deficiency in alveolar O2 exchange.
Reduced PO2 in the lungs (high altitude) or inadequate gas exchange.
2
Q
What is Hypemic Hypoxia?
A
Reduction in the O2 carrying capacity in the blood due to hemorrhage, anemia, and certain drugs.
Lack of O2 carrying capacity to the tissue.
3
Q
What is Histotoxic Hypoxia?
A
Occurs as a result of poisoning or metabolic disorders such as cyanide, ETOH, CO poisoning.
Inability of the cells to accept or use oxygen.
4
Q
What is Stagnant Hypoxia?
A
Reduced cardiac output or pooling of blood such as heart failure, PE, or shock.
Reduced blood flow.
5
Q
A PaCO2 greater than 45 mmHg indicates what?
A
Alveolar Hypoventilation.
6
Q
A PaCO2 less than 35 indicates what?
A
Alveolar Hyperventilation.
7
Q
Normal Range of Hemoglobin (Hgb)
A
12 to 18 g/dL.
8
Q
Normal range for Red Blood Cells (RBC) for Male and Female.
A
Male: 4.3-5.7 cells/mcL
Female: 3.8-5.1 cells/mcL
9
Q
Normal Range for White Blood Cells (WBC)
A
4,500-10,500 cells/mcL
10
Q
What are the three types of Lymphocytes and where do they operate?
A
B cells, CD4+ helper T cells, and CD8+ cytotoxic T cells that operate in the lymphatic system.
11
Q
Normal range for Sodium (Na)
A
135-145 mEq/L
12
Q
Normal range for Potassium (K)
A
3.5-5 mEq/L
13
Q
Normal range for Chloride (Cl)
A
85-105 mEq/L
14
Q
Normal Range for Magnesium (Mg)
A
1.5-2.5 mEq/L
15
Q
Normal range for Calcium (Ca)
A
8.5-10.5 mEq/L
16
Q
Normal range for Phosphorus (P)
A
3-4.5 mEq/L
17
Q
Normal range for Blood Urea Nitrogen (BUN)
A
6-23 mg/dL.
18
Q
Normal range for Creatine (Cr)
A
0.6-1.4 mg/dL.
19
Q
Normal range for Serum Osmolality
A
275-295 mOsm/kg H2O.
20
Q
Normal range for Platelets (Plt)
A
150,000-440,000/ mcL.
21
Q
What is the range for Prothrombin Time (PT)?
A
11-13 seconds.
22
Q
What is the International normalized ratio (INR) for someone not on Warfarin?
A
0.8-1.1
23
Q
What is the International normalized ratio (INR) for someone on Warfarin?
A
2.0-3.0.
24
Q
Normal range for Activated partial thromboplastin time (aPTT)
A
21-35 seconds.
25
Normal range for Fibrinogen
200-400 mg/dL.
26
Normal range for D-dimer
Less than 250 mcq/mL.
27
Normal range for B-type natriuretic peptide (BNP)
Less than 100 pg/mL.
28
Normal range for Troponin-I
Less than 0.04 ng/mL.
29
What is the function of Sodium in the body?
Main electrolyte in the extracellular fluid that helps maintain fluid balance; assists in regulation of acid-base balance.
30
What is the function of Potassium in the body and how is it regulated?
Major cation intracellularly. Regulated mainly by kidneys. Essential for cardiac and CNS function by regulation muscle and nerve excitability.
31
What is Chloride and its function in the body? What does it assist with?
Chief anion of extracellular fluid necessary for potassium retention and transport of CO2; assists in formation of hydrochloric acid in the GI tract.
32
What is Calcium and its function with in the body?
Responsible for blood coagulation, muscle contraction, and nerve excitability.
33
What kind of relationship does Calcium have to Phosphorus?
A reciprocal relationship.
34
What is the function of Magnesium? What other electrolytes does a deficit of Magnesium seen with?
Affects cardiac and neuromuscular function.
Deficits are seen with Calcium and/or Potassium.
35
What is Phosphorus and what role does it play in the body?
Provides mineral strength to bone, integral component of DNA and RNA.
Plays a role in neuromuscular function and forming and storing of ATP.
36
What is BUN?
A byproduct from breakdown of blood, muscle, and protein in the body.
37
What is Creatinine?
A waste product of muscle metabolism.
38
What does Serum Osmolality measure? What partly controls it?
Amount of chemical dissolved in the serum.
Controlled partly by ADH.
39
What is the function of platelets, where is it formed, and how long does it live?
Normal blood clotting.
Bone marrow.
9-12 days.
40
What does Prothrombin Time measure?
The time it takes for the plasma of the blood to clot.
41
What does INR do?
Standardizes the results of Prothrombin Time (PT) no matter the method used to test it.
42
What does Activated partial thromboplastin time measure?
The activity of intrinsic and common pathways of coagulation.
43
What is Fibrinogen?
Protein in the plasma that aids in clot formation.
44
What does D-dimer reflect? What does it rule out?
Ongoing activation of the hemostatic and thrombolytic system.
Rules of PE,DVT, DIC.
45
What is BNP and what does it rule out?
Secreted by ventricles in response to excessive stretching.
Acute heart failure vs. COPD.
46
What is Troponin-I?
Presents in cardiac muscle tissue and released in response to muscle damage in the heart (MI).
47
What is the Haldane effect?
Describes how oxygen concentrations determine hemoglobin’s affinity for CO2.
48
What is Bohr effect?
Describes how CO2 and Hydrogen affect the affinity of hemoglobin for oxygen.
49
With Oxyhemoglobin Dissociation curve, what does a right shift indicate? How does it affect the body?
A decrease affinity of oxygen and hemoglobin.
Raised unloading of oxygen, acid, temperature, 2,3-DPG, and PaO2.
50
With Oxyhemoglobin Dissociation Curve, what does a left shift indicate? What affect does it have on the body?
An increased affinity for oxygen in hemoglobin.
Low O2 release, acid, temperature, 2-3-DPG, and PaO2.
51
For every __ change in CO2, the pH will change __ in the __ direction.
10 mmHg.
0.08.
Opposite.
52
For every __ change in HCO3-, the pH will change by __ in the __ direction.
10 mEq.
0.15.
Same.
53
For every change in pH of __, the K+ will change by __ in the __ direction.
0.10.
0.6.
Opposite.
54
What is Tidal Volume (Vt)? What is the normal range for an adult ?
The normal volume of air inspired during each normal respiratory cycle.
6-8 mL of lean body mass or IBW.
55
What is the sum of respiratory rate set by the ventilator and any triggered breaths by the patient shown as on a ventilator? What does it reflect for a patient?
Frequency (f).
Patient’s work of breathing, PaCO2, and pH.
56
What is FiO2? What is the FiO2 of room air?
Fraction of inspired oxygen shown as a percentage from 21 (21%) to 1.0 (100%).
.21 or 21%.
57
What is plateau pressure and the abbreviation for it?
Amount of pressure placed against alveoli showing alveolar health.
Pplat.
58
What is Minute ventilation (VE)?
The volume of any gas or fluid moved per minute.
59
How is respiratory minute volume calculated? What is the average?
(Vt) • (RR)= VE.
Average is 4-8 L/min.
60
What is Exhaled tidal volume (Vte)? This should be within __ of the set __.
Measurement of the volume of air received by the patient.
+/- 50 mL of set Vt.
61
What is I:E ratio? Which is active and passive? What happens if the expiratory time is of insufficient duration?
Inspiratory and Expiratory Time.
Inspiratory is active. Expiratory is passive.
Gas becomes trapped in the alveoli at the end of expiration.
62
What is I-time and flow?
The basis of how quickly a breath is delivered.
63
What is flow?
Ratio of the amount of total volume delivered per minute based on Vt and I-time that relates to the Inspiratory phase of the I:E ratio.
64
What is PIP? What does it measure? PIP should be kept at what?
Peak inspiratory pressure that is used in volume controlled ventilation. The point of maximal airway pressure.
Measures the amount of pressure at the upper airway, ETT, vent circuit, and bronchial tree.
Less than 40 cmH2O.
65
What is Driving pressure? How do you get driving pressure?
Pressure that opens alveoli.
Pplat- PEEP.
66
What should the driving pressure be kept at or below? Why?
15 cmH2O.
To prevent lung injury or damage to the alveoli.
67
How can you keep Driving Pressure less than 15 cmH2O?
By keeping the Pplat less than 30 cmH2O
Decreasing Vt less than 6 mL/kg
Raising PEEP.
68
What is Pplat and what level should you keep it below?
The measurement of pressure at the alveolar level.
Less than 30 cmH2O.
69
What is the quickest way to increase oxygenation?
PEEP.
70
What is ARDS?
Acute Respiratoy Distress Syndrome. Diffuse alveolar damage and lung capillary injury.
71
What is the early vs. late stage of ARDS?
Early: influx of fluid into alveoli.
Late: Fibroproliferarion (scarring and overgrowth of connective tissue) occurs.
72
What is the pathophysiology of ARDS?
Inflammatory response where pro-inflammatory mediators destroy capillary and alveolar capillary membranes. Alveolar separates from the capillaries.
73
What is Assist Control (AC)? What are the indications for the mode?
Mode of volume control that delivers a preset Vt and RR.
Normal respiratory drive accompanied by conditions causing increased work or breathing and apneic patients.
74
What is Synchronized intermittent mandatory ventilation (SIMV)?
Mode of ventilation that gives a set number of breaths at a preset Vt, but allows the patient to spontaneously breath between mandatory breaths.
75
What is a risk for using SIMV mode?
Increased muscle fatigue.
76
What are the indications for using SIMV? What is SIMV often used with?
Weaning, increased comfort, and reduced chance of hyperventilation.
Pressure Support (PS).
77
What is Pressure Support (PS)?
Pressure applied at the end of vent circuit, used in SIMV to augment the patient’s spontaneous breathing which decreases effort and work load on the patient and assists in weaning process.
78
What is Pressure control ventilation (PC)?
Pressure mode that delivers each breath with a preset rate, Inspiratory pressure, and I:E ratio. Can be used with PS.
79
What is Pinsp and what should the setting be started at for adults and pediatrics?
Inspiratory pressure for the pressure initiated ventilation.
Adults: 20 cmH2O.
Pediatrics: 10-15 cmH2O.
80
What is Pressure regulated volume controlled ventilation (PRVC)?
Mode where ventilator (control breath) and patients (assist breath) initiates breathing with constant pressure applied through out inspiration, regardless of breath.
81
What does PRVC improve and why?
Improves oxygenation because of deceleration Inspiratory flow pattern (consequence of constant pressure).
82
In PRVC mode, what determines the duration of inspiration?
RR and the I:E ratio or I-time.
83
What can PRVC cause?
Gas trapping and auto-PEEP.
84
In PRVC mode, a longer Inspiratory time equal what?
Improved oxygenation and better alveolar recruitment.
85
To quickly calculate IBW, what is a good starting point and how to do calculate IBW from there?
5’0” equal 50kg.
From there, multiply 2 times every inch above 5’0”.
Ex. 5’10” 10 in.•2= 20
20+50 (kg starting weight)= 70 kg.
86
Formula to find Vt
IBW• 4-6 mL
87
What is Boyle’s Law?
Temperature is constant. Decreased pressure= increased volume.
88
What is Charlie’s Law?
Pressure is constant. As temperature increases, volume increases. As temperature decreases, volume decreases.
89
What is Gay-Lussac’s Law?
As temperature increases, pressure increases. As temperature decreases, pressure decreases.
90
What is Dalton’s Law?
Describes pressure exerted by a gas at various altitudes. As altitude increases, gases expand and molecules move further apart.
91
What is Henry’s Law?
The amount of gas dissolved in a solution is directly proportional to the pressure of the gas over the solution.
The more concentrated the gas is in contact with a liquid, the more gas will be dissolved in the liquid.
92
What is Graham’s Law?
Law of Gaseous Diffusion. Gases migrate or diffuse from regions of higher concentration (pressure) to lower concentration (pressure) until equilibrium is reached.
93
S/S Syndrome of Inappropriate Antidiuretic Hormone (SIADH) (3)
Fluid retention without edema
Dilutional hyponatremia
Concentrated Urine
94
What is SIADH?
Syndrome of Inappropriate Antidiuretic Hormone. Abnormal ADH secretion that causes water retention and alters fluid and electrolyte balance.
95
What is the treatment for SIADH?
Fluid restriction
Hypertonic Solution (3% NaCl)
96
What lab findings would you find in a patient with Diabetes Insipidius?
Increased Na+
Increases serum osmolality
Increased urine output
Low specific gravity of urine
97
What is the treatment for DI?
Aggressive IVF replacement
Vasopressin (synthetic ADH)
Desmopressin (DDA VP)
Monitor specific gravity of urine
Monitor for cardio changes
98
What is a Thyroid Storm?
Acute, life threatening exacerbation of thyrotoxicosis.
99
S/S of Thyroid Storm (6)
Hyperpyrexia (fever)
Diaphoresis
Tachycardia
N/V/D
Tremulousness and delirium
Confusion
100
What are the 4 main goals of therapy to prevent a Thyroid Storm?
1) Block the formation of new hormones in the thyroid gland.
2) Inhibit the action of hormones already formed.
3) Support vital functions.
4) Identify and treat the precipitating event.
101
What is the treatment for Thyroid Storm?
Anti-thyroid medication
Glucocorticoid medication
B-adrenergic blocking agent
Supportive Care
102
What is Myxedema Coma?
An extreme manifestation of hypothyroidism.
103
S/S of Myxedema Coma (7)
AMS
Alopecia
HTN (early), Hypotension (late)
Bradycardia
Myexdematous face (hair dry, course, and sparse, thin eyebrows, periorbital edema, puffy, dull face with dry skin)
Dry, cool, doughy skin
Hypothermia
104
What is the treatment for Myxedema Coma?
Supportive care.
IV thyroid hormone replacement.
Administer glucocorticoid.
105
What is Cushing Syndrome?
Prolonged exposure to glucocorticoids.
106
What is Adrenal Insufficiency
Lack of cortisol.
Body cannot maintain essential life functions.
107
Presentation of Adrenal Insufficiency
Weakness
Dizziness upon standing
Loss of appetite
Joint aches and pain
108
Brudzinski's sign
Flexion of the neck usually causes flexion of hip and knee.
Suspect Meningitis.
109
Chvostek's sign
Spasms of the facial muscles elicited by tapping the facial nerve.
Secondary to Hypocalcemia.
110
Cullen's sign
Bluish discoloration around the umbilicus associated with intraperitoneal hemorrhaging.
111
Grey Turner's sign
Bruising of the flank due to retroperitoneal hemorrhaging.
Often seen in pancreatitis.
112
Kernig's sign
The inability to completely extend the leg when sitting or lying down.
Seen in meningitis.
113
Kehr's sign
Referred left shoulder pain.
Suspect injury to spleen.
114
McBurney's sign
Rebound tenderness in RLQ, with deep palpation.
Secondary to appendicitis.
115
Trousseau's sign
Positive when a blood pressure cuff is applied to upper arm and inflated for 3 minutes causing the hand to withdrawal up and spasm due to hypocalcemia.
116
Treatment for Esophageal Varices (7)
Beta-Blockers (non-selective ex: Propranolol, Sotalol, Nadolol, Carvedilol).
Band ligation.
Ocetreotide (Sandostatin).
Diversion of blood.
Balloon tamponade (Sengstaken-Blakemore tube).
Liver transplant.
117
What is a Sengstaken-Blakermore tube?
A ballon tamponade used to treat Esophageal Varices.
By inflation a tube in the esophagus it allows the blood vessels in the esophagus to clot and stop bleeding.
118
What is Mallory-Weiss tear?
Upper GI bleed caused by increased intrathoracic pressure.
119
What is the most common substance that builds up due to Hepatic Encephalopathy?
Ammonia.
120
What classifies as Acute Renal Failure?
A decrease in urinary output (UO) less than 400 cc/24 hr period.
121
What are the 3 main causes of ARF?
1) Pre-renal: Any condition that impedes blood flow outside of the kidneys (CHF, hypotension).
2) Intra-renal: anything that causes direct insult to the kidney (kidney damage from any source like trauma).
3) Post-renal: Backflow of urine into the renal pelvis (bladder obstruction).
122
What are the goals of resuscitation within the first 6 hours of Sepsis?
CVP 8-12 mmHg (12-15 w/ hx of HTN)
MAP >65 mmHg
UO >0.5-1 mL/kg/hr
Mixed venous oxygen saturation (SvO2) 65-70%
Blood Cultures
IV antibiotic within the first hour
123
Proper shut down procedure for most aeromedical aircraft?
Throttle
Fuel
Brake
Oxygen
124
What is VFR?
Visual Flight Rules.
125
What is IFR?
Instrument Flight Rules.
126
What is the quickest way to improve Cardiac Output?
Increase HR.
127
What is the normal Cardiac Output (CO)?
4-8 L/min.
128
Formula to find SVR
SVR= 80* (MAP-CVP)/ CO
129
Axis Deviation: Normal Axis range
-30 to +90.
130
Axis Deviation: Left Axis range
-30 to -90.
131
Axis Deviation: Right Axis range
90 to 180.
132
Leads II, III, aVF provide blood to what coronary artery?
RCA.
133
Leads v1-v4 provide blood to what coronary arteries?
LAD, L Main.
134
Leads I, aVL, v5, and v6 provide blood to what coronary artery?
LCX.
135
Sgarbossa Criteria
Concordant STE greater than or equal to 1 mm 5 points
STD greater than or equal to 1 mm in V1-V3 3 points
Discordant STE greater than or equal to 5 mm 2 points
136
Where are Central venous catheters placed?
Subclavian, EJ or IJ, Femoral or AC veins.
137
What is the proximal port on a PAC used for?
CVP monitoring or drug administration.
138
What is the thermistor port on a PAC used for?
monitor CO
139
What is the distal port on a PAC used for?
Monitor PA, Sv02, blood draw, and PWCP.
140
CVP/RAP range
2-6 mmHg.
141
Right Ventricular Pressure (RVP) range. RVS RVD.
Systolic: 20-30 mmHg
Diastolic: 0-5 mmHg
142
Pulmonary Artery Systolic Pressure (PAS) range
15-25 mmHg.
143
Pulmonary Artery Diastolic Pressure (PDS) range
8-15 mmHg
144
What is PCWP and the range?
Pulmonary Capillary Wedge Pressure.
8-12 mmHg.
145
How does a IABP work?
Balloon inflates after LV contraction and deflates before LV contraction.
146
Where is a IABP positioned?
1-2 cm below the subclavian artery and above the renal arteries.
147
On CXR, where should the tip be visible on a IABP?
between the 2nd and 3rd intercostal spaces.
148
Rust in pressure lines in IABP indicate what?
Helium leak.
149
Sign of Early Inflation
Absence of large V or Dicrotic Notch (may be hidden due to Augmented Diastole being closer to systole). Bad sign.
150
Sign of Late Inflation
Absence of sharp "V" or dicrotic notch exposed. Because its late to inflate, DN looks wide.
151
Sign of Early Deflation
Absence of "U". Augmented Diastole is not a "V" shape.
152
Sign of Late Deflation
Worse Timing Error. Between the augmented diastole and the assisted end diastole shows a plateau and a small "V".
153
What controls thermoregulation?
The Hypothalamus.
154
Mild hypothermia range
32-35 Degrees C (89.6-98.6 F)
155
Moderate hypothermia range
28-32 C (82.4-89.6 F)
156
Severe hypothermia range
less than 28 C (less than 82.4 F)
157
What is Conduction?
Direct physical contact transferring hear from warmer object to cooler object.
158
What is Convection?
Heat transferred through air and water vapor molecules around the body.
159
What is Radiation?
Heat transferred by electromagnetic waves.
160
What is Evaporation?
Converting liquid to gas for heat transfer.
161
Antidote for Carbon Monoxide
Oxygen
162
Antidote for Cyanide
Amyl nitrate, NA thiosulfate
163
Antidote for Organophosphates
Atropine, 2-PAM Chloride
164
Antidote for Methemoglobinemia
Methylene Blue
165
Antidote for Anticholinergic
Physostigmine
166
Antidote for Coumadin
Vitamin K, FFP
167
Antidote for Heparin
Protamine Sulfate
168
Antidote for Beta Blockers and CCB
Glucagon, Calcium
169
Antidote for Benzodiazepines
Romazicon (Flumazenil)
170
Antidote for Digitalis
Digibind
171
Antidote for Ethylene gylcol, Proylene gylcol
IV Ethanol, Fomepizole
172
Antidote for Methanol
IV Ethanol, Fomepizole, Folic Acid
173
Antidote for Potassium Cyanide
Methylene Blue
174
Antidote for Tricyclic antidepressants
Bicard, 3% NS
175
Antidote for Tylenol
Mucomyst
176
Signs of Beck's Triad
Narrowing pulse pressures
Muffled heart sounds
JVD
177
Parkland Burn Formula
Kg times TBSA times 2-4 mL= volume given over 24 hours. Administer first half over next 8 hours
178
Combination of Brooks Modified and Parkland formula
Kg times TBSA times 2-4 mL= volume given over 24 hours
2mL/kg- Adults
3 mL/kg- Pediatrics less than 30 Kg
4 mL/kg- Electrical burns
Pediatrics greater than 30 kg
179
S1 sound and what it represents.
"lub" sound
Mitral and Tricuspid valve closing.
180
S2 sound and what it represents.
"dub" sound
Aortic and Pulmonic valve closing.
181
S3 sound and what it means.
"Ken-TUCKY" sound
Passive filling of the Left Vent. and a complaint Left Vent. Seen in athletes with high CO.
182
S4 sound and what it means.
"Ten-nessee" sound
Late diastolic and high atrial pressure.
183
Correct location to listen to heart tones.
At the apex of the left vent. or 5th intercostal space.
184
Hemodynamic in Right Failure. CVP, CI, SVR, PCWP.
CVP High
CI Low
SVR High
PCWP Low
185
Hemodynamic in Hypovolemia. CVP, CI, SVR, PCWP.
CVP Low
CI Low
SVR High
PCWP Low
186
Hemodynamic in Cardiogenic. CVP, CI, SVR, PCWP.
CVP High
CI Low
SVR High
PCWP High
187
Hemodynamic in Neurogenic. CVP, CI, SVR, PCWP.
CVP Low
CI Normal or on Low end of normal
SVR Low
PCWP Low
188
Hemodynamic in Obstructive. CVP, CI, SVR, PCWP.
CVP High
CI Low
SVR High
PCWP High
189
Hemodynamic in Distributive. CVP, CI, SVR, PCWP.
CVP Low
CI Low
SVR Low
PCWP Low
190
Cardiac Index (CI) Range
2-4 L/min
191
What does a high SVR mean?
The patient is vasoconstricted hemodynamically.
192
What does a low SVR mean?
The patient is vasodilated hemodynamically.
193
Formula to find SVR
[(MAP-CVP)/Q] times 80
194
Formula to find PVR
(MEAN PAP/Q)- PCWP times 80
195
Formula to find CO
(SVR times HR)/ 1,000
196
Formula to find CI
Q/BSA
197
What is PCWP a reflection of?
Left side Preload
