aasccpflashcards.txt

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aasccpflashcards.txt
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Critical Care Paramedic flashcards
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  1. What does SVR measure?
    After-load of the left side of the heart
  2. What are the normal values for monitoring PAP pressures?
    15-25/8-15 mmHg
  3. How does Angiotensin II impact the cardiovascular system?
    Increasing both preload and afterload by vasoconstriction (afterload) and increasing urinary retention (preload)
  4. Your patient is experiencing left ventricular diastolic dysfunction. What should therapy be focused on?
    Increasing preload; impaired filling of the ventricles equals inadequate filling pressures; increasing preload increases filling pressures
  5. Your patient is experiencing right ventricular diastolic dysfunction. What should therapy be focused on?
    Increasing force of contraction; ventricle is having a problem pumping forcefully; positive inotropic agents i.e. Dopamine
  6. The patient's peripheral A-line is showing a very sharp waveform with readings that appear jagged and exaggerated. This may be due to:
    Catheter whip
  7. Overdampened waveforms can do what to blood pressure readings?
    Underestimate them
  8. Your patient's PA waveform has suddenly changed to resemble a low amplitude rolling waveform. This is most likely due to:
    An inadvertent advance to wedge
  9. When assessing CVP or PAWP pressures on a mechanically ventilated patient, the pressures should be assessed at:
    The end of exhalation
  10. The dicrotic notch on the PA waveform indicates:
    Closure of the pulmonic valve
  11. The patient's PA catheter is exhibiting a large, well defined waveform with an obvious "notch" on the left side of the waveform. The distal tip is most likely in the:
    Right ventricle
  12. A patient in early shock most probably has which acid-base imbalance?
    Respiratory alkalosis
  13. Treatment of pancreatitis would NOT include...
    Morphine for pain- it can increase spasms at sphincter of Oddi
  14. The clotting cascade can be triggered through an extrinsic pathway. The triggering mechanism is the release of?
    Tissue thromboplastin
  15. Your patient presents with the following: CVP 2, CI 6.4, PA S/D 34/16, wedge 7 and SVR 400. What is your diagnosis?
    Septic shock
  16. What would the blood test BNP evaluate a patient for?
    Congestive heart failure
  17. What are your primary medications for a patient presenting with a suspected AAA?
    Nipride and Beta Blockers
  18. The balloon has dislodged when treating your IABP patient. Which is the most common site that will be affected?
    Left radial
  19. During transport you notice rust colored "flakes" in the IABP tubing. This indicates...
    Balloon rupture
  20. During transport you experience a complete IABP failure. You should...
    Cycle the balloon manually every 30 minutes regardless of timing to prevent formation of clots
  21. Acute respiratory failure is defined as:
    pO2 <60 mmHg and pCO2 >50 mmHg
  22. What measurements are indicators of right-side preload?
    • Right atrial pressure (RAP)
    • Central venous pressure (CVP)
    • Pulmonary vascular resistance (PVR)
  23. What measurements are indicators of left-side preload?
    • Left atrial pressure (LAP)
    • Pulmonary artery "wedge" pressure (PAWP)
    • Pulmonary wedge pressure (PWP)
    • Pulmonary capillary wedge pressure (PCWP)
    • Pulmonary artery occlusive pressure (PAOP)
    • Systemic vascular resistance (SVR)
  24. What measurements are indicators of pressure in the pulmonary artery?
    • Pulmonary artery pressure (PAP)
    • Pulmonary artery systolic (PAS)
    • Pulmonary artery diastolic (PAD)
  25. What measurements are indicators of afterload?
    • Cardiac Index (CI)
    • Cardiac Output (CO)
    • Stroke Volume (SV)
    • Left ventricular end-diastolic pressure (LVEDP)
    • Left ventricular end-diastolic volume (LVEDV)
  26. How do you calculate Cardiac Output?
    SV x HR
  27. How do you calculate SV?
    EDV-ESV
  28. How do you calculate ejection fraction?
    SV divided by EDV
  29. What is normal ejection fraction?
    • 55-75%
    • Most important predictor of prognosis
  30. How do you calculate CPP (coronary perfusion pressure)?
    • DBP - PAWP
    • Normal value 50-60
    • Can substitute PAD if no wedge
  31. What is normal wedge?
    8-12 mmHg
  32. What is normal CVP?
    2-6 mmHg
  33. What is normal PVR?
    100-250
  34. What is normal PAS?
    15-25 mmHg
  35. What is normal PAD?
    8-15 mmHg
  36. What is normal cardiac index?
    2.5 - 4.3 L/min
  37. What is normal SVR?
    800-1200
  38. What types of shock should you consider if your SVR is low (<800)?
    Vasodilatory or distributive
  39. If your SVR is low and your CI is high, what type of shock do you have?
    Septic
  40. If your SVR is low and your CI is low, what is the next thing to look for?
    • HR
    • If tachycardic, you have anaphylactic shock. If normal or low HR, you have neurogenic shock.
  41. What types of shock should you consider if your SVR is high (>1200)?
    Hypovolemic, Cardiogenic, or RV AMI
  42. If your SVR is high and your CVP is <2, what kind of shock do you have?
    Hypovolemic
  43. If your SVR is high and your CVP is normal or low, what condition do you have?
    RV AMI
  44. If your SVR is high and your CVP and wedge are high, what kind of shock do you have?
    Cardiogenic
  45. What is the mechanism of action of ACE inhibitor drugs?
    Vasodilation, thus decreasing afterload
  46. What is the mechanism of action of Angiotenson II Receptor Blockers (ARBs)?
    Decrease systemic afterload, decreasing the workload of the LV
  47. What is the most common insertion site for a PAC?
    Right internal jugular
  48. What does PAC stand for?
    Pulmonary artery catheter, aka Swan-Ganz catheter
  49. On CXR, where should tip of PAC be seen if placed properly?
    2nd or 3rd intercostal space
  50. What is the maximum amount of air that can be placed in balloon port (red port) for a wedge?
    1.5 cc
  51. If you can only monitor one port on a PAC, which port should you monitor?
    Distal (PA) Yellow port
  52. What does transducer leveling do?
    Eliminates the influence of hydrostatic pressure on the transducer
  53. When should transducer leveling be performed?
    After every change in patient position
  54. What axis should transducer leveling be performed at?
    Phlebostatic axis, where the nipple line and mid-axillary line meet at approximately fourth intercostal space
  55. What can cause catheter whip?
    High blood pressures, length of tubing, or movement of the catheter tip
  56. What does an overdampened waveform present like on the monitor?
    • Slow return to baseline
    • Waveform appears "squeezed down" from too much pressure
  57. What can cause overdampened waveforms?
    • Overly compliant tubing
    • Air bubbles
    • Clots
    • Catheter kinks
    • Low flush bag pressure (need minimum 300 cc)
  58. What does an underdampened waveform present like on the monitor?
    • More than two oscillations after fast flush test
    • Exaggerated waveform
  59. What can cause underdampened waveforms?
    • Non-compliant tubing
    • Increased vascular resistance
    • High systolic and low diastolic pressures
    • Loose connections
    • Air in the system
    • Altitude changes
  60. In a dampened waveform, what should you always do first to try to correct?
    Aspirate, do not flush in case of clots
  61. What waveform group has a dicrotic notch?
    Arterial waveforms
  62. What waveform group has a, c, v waves and x and y descent?
    Atrial waveforms
  63. What unique notch do ventricular waveforms have?
    Anacrotic notch that correlates with QRS
  64. What measurements do Atrial waveforms read?
    • Preload measurements
    • CVP/RAP
    • PAWP/LAP
  65. What measurements do Arterial waveforms read?
    • BP
    • A-line
    • PA
  66. In an atrial waveform, what does the a-wave indicate?
    Atrial contraction (prior to onset of QRS)
  67. In an atrial waveform, what does the c-wave indicate?
    Ventricular contraction and closure of tricuspid valve (occurs within the QRS)
  68. In an atrial waveform, what does the x descent indicate?
    Atrial relaXation (occurs after the QRS)
  69. In an atrial waveform, what does the v-wave indicate?
    PassiVe atrial filling (occurs just after T-wave)
  70. In an atrial waveform, what does the y descent indicate?
    Atrial emptYing and opening of the tricuspid valve
  71. How do you manage an inadvertent wedge position?
    • Check balloon, make sure it is deflated
    • Have patient cough forcefully
    • Change position of patient (elevate head slightly)
    • RAPID TRANSPORT - DO NOT PULL CATHETER BACK
  72. What does it mean if you have a wedge reading of 15-18?
    Ideal wedge in CHF patient
  73. What does it mean if you have a wedge reading of 18 or less than 12?
    ARDS
  74. What does it mean if you have a wedge reading of 20?
    Mild pulmonary congestion
  75. What does it mean if you have a wedge reading of 25?
    Moderate pulmonary congestion
  76. What does it mean if you have a wedge reading of 30?
    Severe pulmonary congestion
  77. What could large v-waves indicate on wedge tracing?
    Mitral valve regurgitation
  78. What does the dicrotic notch on the PA waveform indicate?
    Closure of the pulmonic valve
  79. What are some causes of elevated PAP?
    • Increased PVR
    • Left to right shunts (patent ductus arteriosus)
    • Left ventricular failure
    • Mitral regurgitation and stenosis
  80. What does the dicrotic notch on the A-line waveform indicate?
    Closure of the aortic valve
  81. What does the highest point of the A-line waveform correlate with?
    Systolic pressure; T-wave on EKG
  82. What does the lowest point of the A-line waveform correlate with?
    Diastolic pressure; end of QRS on EKG
  83. What is Cullen's sign and what does it indicate?
    • Bruising around umbilicus
    • Can indicate pancreatitis, peritoneal or retroperitoneal hemorrhage
  84. What is Grey-Turner's sign and what does it indicate?
    • Bruising to the flank area
    • Can indicate pancreatitis and retroperitoneal hemorrhage
  85. What is HalsteAd's sign and what does it indicate?
    • Marbled abdomen
    • Can indicate necrotic pancreas
  86. What is Halsted's sign and what does it indicate?
    • Breast discoloration
    • Can indicate breast cancer
  87. What is the primary treatment for hepatic encephalopathy?
    Evacuate any blood present in the gut via OG/NG tube to decrease ammonia levels
  88. What is the treatment for esophageal variceal hemorrhage?
    Vasopressin and S-Blakemore tube
  89. What structure defines lower versus upper GI?
    The Ligament of Treitz - suspensory ligament of the duodenum
  90. What is Markel's sign and what does it indicate?
    • Rebound tenderness on palpation
    • Can indicate peritoneal irritation or appendicitis
  91. What is Rovsing's sign and what does it indicate?
    • Referred pain to RLQ when LLQ is palpated
    • Can indicate appendicitis
  92. What is Aaron's sign and what does it indicate?
    • Referred pain felt in epigastric region upon continuous firm pressure over McBurney's point (iliac to umbilicus, form a v)
    • Diagnostic for appendicitis
  93. What is Psoas sign and what does it indicate?
    • Patient lying on side hyperextension or flexion of hip elicits RLQ pain
    • Can indicate appendicitis
  94. What is Kehr's sign and what does it indicate?
    • Referred shoulder pain while supine
    • Spleen injury/rupture (left shoulder)
    • Ectopic pregnancy (either shoulder)
  95. What is Balance sign and what does it indicate?
    • Dullness to percussion of LUQ with a shifting dullness to RUQ, both due to blood
    • Can indicate spleen injury or rupture
  96. What is Murphy's sign and what does it indicate?
    • Pain on inhalation or coughing when RUQ is palpated
    • Inflammation of gallbladder; diagnostic of cholecystitis
  97. What is Linea Nigra and what does it indicate?
    • Darkening "line" of skin from umbilicus to pubic symphysis
    • Indicates pregnancy
  98. One unit of PRBC's equals approximately ___ mL and increases H/H by ____%.
    330 mL and 1/3 or 33%
  99. What is the pediatric dose for PRBC's?
    10 cc/kg
  100. What is the universal blood donor type?
    O
  101. What is the universal recipient blood type?
    AB
  102. What is FFP and what is it useful in correcting?
    • Fresh Frozen Plasma
    • Volume expander or to increase clotting factors
    • Corrects Warfarin induced hemorrhage or toxicity, along with Vit K
  103. What is cryoprecipitate and what types of conditions is it used for?
    • Corrects low fibrinogen levels
    • Used in DIC, Hemophilia A and Von Willebrand's disease (Factor VIII)
  104. What are the four types of blood transfusion reactions?
    • Hemolytic - short onset
    • Anaphylactic - 30 min onset, treat with epi
    • Febrile - 30-90 min onset
    • Circulatory overload - can occur anytime, treat with Lasix
  105. What is the problem in Hemophilia A patients?
    Cannot form a stable fibrin clot
  106. What is the problem in Hemophilia B patients?
    • AKA Christmas disease
    • Prolonged partial thromboplastin (PT) times
  107. What is the problem in Von Willebrand's patients?
    Defective platelet adherence; cannot form platelet plugs
  108. What is the drug of choice for treatment of vasodilatory shocks?
    • Levophed (Norepinephrine)
    • Increases vascular tone through alpha-adrenergic receptors
  109. What are the 7 P's of Spinal Cord injury?
    • Pain
    • Position
    • Ptosis, Pinpoint pupils
    • Parasthesias
    • Paralysis
    • Priapism
    • Poikilothermia
  110. What is the problem in a patient with Graves disease?
    • Increased levels of thyroid hormones
    • Avoid ASA - releases T3 and T4 hormones
    • Treatment is steroids (Dexamethasone)
    • Can present with tremors, weight loss, AFib, expothalmus, goiter
  111. What is the problem in a patient with myxedema coma?
    • Hypothyroidism
    • Treatment is Levothyroxine
    • Can present with coarse hair, fatigue weight gain
  112. What is the main problem in a patient with hypoparathyroidism?
    Hypocalcemia - PTH regulates calcium levels
  113. In a patient with a head injury, you note extreme urinary output with very low specific gravity. What is your initial treatment of this patient?
    • Aggressive fluid replacement and vasopressin
    • Diabetes Insipidus is often caused by head injury, due to a deficiency of ADH from posterior pituitary gland
    • Can result in hypernatremia (possible SZ) and hypokalemia if untreated
  114. What is the main problem in SIADH?
    • Overproduction of ADH which can be caused by anything that interferes with renal excretion of water
    • Can result in dilutional hyponatremia and hypokalemia
    • Treatment is to restrict fluids and correct electrolytes - hypertonic 3% NS
  115. What is Cushing's Disease?
    • Increased levels of cortisol, usually caused by an anterior pituitary tumor
    • Presents with moon face, buffalo hump, upper body obesity with thin extremities, hypertension
    • Treated with steroids
  116. What is Addison's Disease?
    • Acute Adrenal Insufficiency - Adrenal glands not producing enough cortisol
    • Presents with asthenia, severe fatigue, weight loss, darkening of skin, hypotension
  117. What drug is to be used with extreme caution in Addison's disease patients?
    Etomidate - refractory hypotension 8-10 hours later
  118. What is Conn's Syndrome?
    • AKA Hyperaldosteronism
    • Usually caused by adrenal tumor known as pheochromocytoma
    • Can lead to hypokalemia, hypernatremia, hypertension, alkalosis
    • Treated with Spironolactone (works as aldasterone antagonist)
  119. What is the treatment for HHNK?
    • Aggressive fluids
    • Short acting/regular insulin
  120. What lab value needs to be closely monitored in DKA patients being treated with insulin?
    Potassium - If falls below 3.3, insulin needs to be stopped and K+ administered to correct hypokalemia
  121. What EKG finding should force you to automatically consider RVMI?
    ST elevation of 1 mm or greater in aVR
  122. If a Q wave greater than 25% of the height of the QRS with ST elevation, you should...
    Suspect acute infarct
  123. If a Q wave is present with ST depression...
    It is indeterminate
  124. If a Q wave is present with no ST changes...
    There is an old infarct
  125. If you suspect an inferior infarct, what coronary artery do you expect to be affected?
    RCA
  126. If you suspect a lateral infarct, what coronary artery do you expect to be affected?
    Circumflex
  127. If you suspect a septal or anterior infarct, what coronary artery do you expect to be affected?
    LAD
  128. If you suspect a posterior infarct, what coronary artery(s) do you expect to be affected?
    RCA and Circumflex
  129. What are three things you should look for if you suspect a Posterior infarct?
    • Progressive, tall R waves
    • Slight ST elevation in V6
    • Reciprocal changes in V1-V3
  130. What can U waves indicate on EKG?
    Hypokalemia
  131. What is a common complaint from patients suffering from digitalis toxicity?
    yellow halos
  132. In a patient who has undergone a heart transplant, what drug would be useless in treatment of symptomatic bradycardia?
    Atropine - Vagus nerve is not re-transplanted with heart
  133. What does FAEDE stand for?
    • Fluids
    • Atropine
    • External Pacer
    • Dopamine/Dobutrex drip
    • Epinephrine drip
  134. What drugs are contraindicated in the patient with WPW?
    • Adenosine
    • Diltiazem
    • Digoxin
    • Verapamil
    • Drug of choice: Amiodarone
  135. What is BNP?
    • Brain Natriuretic Peptide
    • Assists in diagnosis of CHF
    • >100 positive, >500 severe
  136. What are some hallmarks of pulmonary edema on CXR?
    • Fluffy margins
    • Kerley B lines
    • Pleural effusions
    • Cardiomegaly
  137. What presentation does ARDS have on CXR?
    • Ground glass
    • No Kerley B lines
  138. What presentation does pericardial effusion have on CXR?
    Enlargement of cardiac silhouette with characteristic water bottle appearance
  139. What does pericardial effusion present with on 12-lead EKG?
    Electrical alternans - increase and decrease in amplitude of R waves
  140. If PAWP = PAD, what should you suspect?
    Cardiac tamponade
  141. What is Dressler's syndrome?
    • Secondary form of pericarditis two to three weeks after injury to the heart or pericardium
    • Presents with fever, pleuritic pain, and pericardial effusion
  142. What are Janeway lesions?
    • Raised red lesions seen on fingers, palms, and soles of feet - painless
    • Indicate Endocarditis
  143. What are Osler's Nodes?
    • Painful raised reed lesions seen on fingers, palms, and soles of feet
    • Indicate Endocarditis
  144. What is the most common cardiac cause of clubbed fingers?
    Congenital cyanotic heart disease
  145. What is a cause of clubbed fingers aside from congenital heart disease and chronic hypoxia?
    Subacute bacterial endocarditis
  146. What does an aortic dissection present with on CXR?
    • Mediastinal and/or aortic widening
    • Left pleural effusion
  147. What is Hill's Sign?
    • Difference in SBP greater than or equal to 20 mmHg between brachial and popliteal BP
    • Indicates acute aortic insufficiency
  148. Where does the tear occur in a AAA?
    The tunica intima
  149. What is Marfan's syndrome?
    • A connective tissue disorder characterized by joint laxity, scoliosis, long upper extremities
    • Associated with dilation of the ascending aorta
  150. What is Turner's syndrome?
    • Missing X chromosome (only occurs in females)
    • Webbed necks is most identifiable physical characteristic
  151. How do we manage an aortic dissection?
    • 2 large bore IVs, restrict fluids unless patient is hypotensive
    • Nitroprusside to lower BP to 100-110 mmHg systolic
    • Beta blockers
    • Pain analgesics
    • Definitive treatment is surgery
  152. What is Virchow's Triad?
    • Pain
    • Flushed skin
    • Swelling
    • Indicates DVT
  153. What is the treatment for DVT?
    • Elevate extremity
    • Heat
    • Analgesia
    • Anticoagulants
  154. How much can IABP augment cardiac output?
    10-20%
  155. When does the IABP balloon inflate?
    During diastole, with the closure of the aortic valve
  156. What is the main benefit to placing an IABP?
    Decrease afterload
  157. What does the dicrotic notch on a balloon pump timing strip indicate?
    Closure of the aortic valve
  158. What is the primary indication for IABP placement?
    Cardiogenic shock
  159. What is the primary contraindication for IABP placement?
    Severe aortic insufficiency
  160. When using the ECG to trigger an IAB, what is the synchronization point for balloon inflation?
    With the T-wave
  161. When using an A-line to trigger an IAB, what is the synchronization point for balloon inflation?
    With the dicrotic notch on the A-line waveform
  162. Where should the distal tip of the IAB be seen on CXR?
    At the level of the 2nd or 3rd intercostal space
  163. Where should the proximal end of the IAB be?
    Above the renal artery
  164. Where should the distal end of the IAB be?
    In the descending aorta, just distal to the left subclavian artery
  165. If your patient experiences a distal dislodgement (most common) of the IAB, which site will be affected?
    Left radial artery
  166. If your patient experiences a proximal dislodgement of the IAB, which site will be affected?
    • Renal arteries, resulting in decrease in urine output
    • Possibly also the femoral arteries
  167. Acute respiratory failure is defined as:
    pO2 <60 mmHg and pCO2 >50 mmHg with pH <7.25
  168. What are some causes of respiratory acidosis?
    • Airway obstruction
    • CNS depressant medications (hypoventilation)
    • Myasthenia gravis
    • Guillain-Barre
    • COPD
    • Pickwickian syndrome
  169. What are some causes of respiratory alkalosis?
    • Excessive mechanical ventilation
    • Fever
    • Anxiety
    • Pain
    • Third trimester pregnancy
    • Drugs
    • CNS
    • Hyperventilation
  170. What are some causes of metabolic alkalosis?
    • Vomiting, NG suction
    • Hypokalemia
    • Thiazide or loop diuretics
  171. How do you calculate Anion Gap?
    • Na - (Cl +HCO3) = AG
    • Normal is 12 (+ or - 4)
  172. What is the mnemonic for differential diagnoses of metabolic acidosis?
    MUDPILERS
  173. What does MUDPILERS stand for?
    • Methanol
    • Uremia
    • DKA
    • Propolene glycol
    • INH/Iron
    • Lactic acidosis
    • Ethylene glycol
    • Renal failure/Rhabdomylosis
    • Salicylates/Starvation ketoacidosis
  174. What is the normal value for K+?
    3.5 to 5.0
  175. What is the normal value for Ca?
    8.8 - 10.4
  176. What is the normal value for Mg?
    1.5-2.5
  177. What is the normal value for Na?
    135-145
  178. What is the normal value for glucose?
    70-110
  179. What is the normal value for BUN?
    6-23
  180. What is the normal value for Creatinine?
    0.6-1.4
  181. What does creatinine measure?
    Kidney function
  182. What is the normal value for CK/CPK?
    60-400
  183. What does CK/CPK measure?
    Muscle enzymes (rhabdo)
  184. What is the normal value for ammonia in an adult?
    15-45
  185. What is the normal value for ammonia in a pediatric?
    40-80
  186. What is the normal value for BNP?
    <100
  187. What is the normal value for WBC?
    4.5-10.5 (peds slightly higher)
  188. What is the normal value for Hgb?
    12-18
  189. What is the normal value for Hct?
    36-52
  190. What is the normal value for platelets?
    140-400
  191. If your pCO2 is <35 mmHg in a ventilated patient, what should you do?
    • Decrease tidal volume
    • Decrease RR
    • Consider sedation/analgesia
  192. If your pCO2 is >45 mmHg in a ventilated patient, what should you do?
    • Increase ventilation first by increasing tidal volume
    • Then increase respiratory rate
  193. What is typical tidal volume for an adult patient?
    5-8 cc/kg (ideal body weight)
  194. What is the oxygen formula?
    PSI x cylinder divided by liter flow = time of O2 remaining
  195. How does asthma present on CXR?
    • SQ air upper lobes
    • Hyperinflated lungs
    • Elongated heart
    • Pneumomediastinal air "leaks"
  196. How does emphysema present on CXR?
    • Large, hyperinflated lungs
    • Low set diaphragm
    • Increased AP diameter
    • Vertical heart
    • Increased retrosternal air
    • BLEBS
  197. How does Chronic Bronchitis present on CXR?
    Bronchovascular structures have irregular contours - only finding
  198. Which toxicity presents with a profound anion gap?
    Ethylene glycol
  199. What is basic treatment of a snakebite?
    • Immobilize affected limb below level of heart
    • NO ICE
    • Obtain fibrinogen levels and CMP
  200. What is basic treatment of a spider bite, scorpion sting, or hymenoptera sting?
    • Ice, analgesia
    • Immobilize affected area
    • Watch for anaphylaxis
  201. What is the first line treatment for Rocky Mountain Spotted Fever?
    Doxycycline (Tetracycline)
  202. If your pregnant patient experiences initial "tearing" pain, then has relief from pain, then experiences pain during contractions only, what may she be presenting with?
    Uterine rupture
  203. If your pregnant patient experiences a "tearing" pain without relief between contractions, what may she be presenting with?
    Abruptio Placenta
  204. How should you treat a pregnant patient with third trimester bleeding?
    • Treat for shock
    • Rapid transport
    • Aggressive tocolytics if contracting
  205. What sign may be present in a patient presenting with uterine rupture?
    Kehr's sign - referred shoulder pain
  206. What position should a pregnant patient be placed in to avoid supine hypotensive syndrome?
    Left lateral recumbent >24 weeks gestation
  207. What is Coopernail's sign and what does it indicate?
    • Bruising to the genitalia
    • Indicates pelvic fracture
  208. What is McDonald's rule?
    • Estimates weeks gestation by fundal height
    • 20-24 weeks the height of the fundus should be at the umbilicus
  209. What are some changes that take place in the pregnant female?
    • Tidal volume increases by 20%
    • Blood volume increases by 30-50%
    • Delayed gastric emptying
    • Slight respiratory alkalosis
    • Hormones soften joints
  210. What does LOCK stand for in treating OBGYN patients?
    • Left lateral recumbent position
    • Oxygen
    • Correct or improve contributing factors
    • Keep reassessing FHR and intervene when indicated
  211. What are the drugs of choice when treating hypertension in pregnant patients?
    • Hydralazine
    • Labetolol
  212. What is DR. C BRAVADO and what is it used for?
    • OBGYN patients in the first 20 mins of contact
    • DR - determine risks
    • C - contractions
    • BR - baseline rate
    • A - accelerations
    • VA - variability
    • D - decelerations
    • O- overall impression and treatment plan
  213. What are some common causes of fetal tachycardia?
    • Maternal fever - most common
    • Methamphetamine use
    • Sympathomimetic use
  214. What is the goal DBP in PIH and Pre-Eclampsia?
    90-110 mmHg
  215. What medication should not be administered to insulin-dependent diabetic mothers?
    Terbutaline - transient hyperglycemic response
  216. What is HELLP syndrome?
    • Hemolysis
    • ELevated liver enzymes
    • Low Platelet ccount
  217. What are three factors that assist in confirming SROM?
    • Positive pooling in vaginal vault with speculum exam
    • Nitrazine paper
    • Positive ferning
  218. What is macrosomia?
    Large baby for gestational age
  219. What is Chadwick's sign?
    • Darkening of cervix, vagina, and vulva
    • Indicates pregnancy
  220. What defines PPH post partum hemorrhage?
    • Decrease in/absent uterine tone
    • Vaginal bleeding >500 cc/24 hrs
  221. What is the treatment of PPH?
    • Shock treatment and rapid transport
    • Infusion of oxytocics (only after placenta delivered)
    • Bimanual compression of uterus maintained for 2-5 mins
  222. What are some causes of uterine inversion?
    • Inappropriate fundal pressure
    • Excessive traction on umbilical cord
    • Mass in the vagina
    • Uterine atony
  223. What is the treatment for uterine inversion?
    • Treat for shock and rapid transport
    • Manual replacement of the uterus
    • Oxytocics should follow replacement of uterus
  224. What is the formula for ETT depth in neonates?
    6 + weight in kg = cm at the gums
  225. What is the most common cause of neonatal seizure?
    Hypoglycemia
  226. A PDA dependent patient may require the administration of which drug during transport?
    • Prostaglandin
    • Primary complication is apnea
  227. What can cause closure of a PDA?
    • High concentrations of oxygen
    • Indomethacin (Indacin)
  228. What four defects make up the Tetralogy of Fallot?
    • Pulmonary stenosis
    • Right ventricular hypertrophy
    • Over-riding aorta
    • Ventricular septal defect
    • Surgical repair is called Rastelli
  229. What is a TET spell?
    • VSD resulting in bluish skin during episodes of crying or feeding
    • Peak incidence between 2 to 4 months of life
  230. What is a scaphoid abdomen indicative of in a neonate?
    • Diaphragmatic hernia
    • Requires oral gastric tube and oral intubation
  231. What is an omphalocele?
    Malformation in which abdominal contents protrude into the base of the umbilical cord
  232. What is a gastroschisis?
    • Opening in the abdominal wall that allows stomach and intestines to extend outside of the body
    • Does not involve the umbilical cord
  233. What are the risks of an omphalocele or gastroschisis?
    • Infection and hypothermia
    • Cover the contents and administer antibiotics
  234. What is Potter's syndrome?
    • Renal agenesis (absence of the kidney(s))
    • Deformed lower extremities
    • Oligohydramnios
    • Pulmonary hypoplasia caused by enlarged bladder
  235. The pediatric patient may be pre-treated with which medication prior to administering Anectine?
    • Atropine
    • All children under 12 years due to increased vagal response to laryngoscopy
    • Given ideally 2-3 mins prior to paralytic
  236. What is the formula to estimate ET tube size in peds?
    16 + age in years / 4
  237. What is the formula to estimate ET tube depth in peds?
    ETT size x 3
  238. What is the age of pediatric patient on which a needle cric may be performed?
    11
  239. What is the age of pediatric patient on which a nasal intubation may be performed?
    12
  240. What mechanical ventilation adjustments may be needed in a patient presenting with status asthmaticus?
    • Large tidal volumes may be required
    • Longer expiratory tims required
  241. What is the drug of choice in pediatric asthma sedation?
    • Ketamine
    • Has bronchodilatory properties
    • Decreases the incidences of mucus plugging in pediatric patints with asthma
  242. How do we manage status asthmaticus?
    • Humidified oxygen
    • IV rehydration
    • Continuous nebulized beta-2 agents
    • Atrovent, corticosteroids, Terbutaline, intubation
  243. What is steeple sign?
    • Narrowing of the airway seen on an A/P chest radiograph
    • Laryngotracheobronchitis (croup)
  244. What is thumb print sign?
    • Thumb print seen on lateral neck radiograph
    • Epiglottitis
  245. What is Waddell's sign?
    • Injury pattern seen in pediatric pedestrian vs MVC
    • Head, abdomen, lower extremities
  246. What are the most commonly injured internal organs in pediatric trauma?
    Spleen and liver
  247. What does LEMONS stand for?
    • Look externally
    • Evaluate 3:3:2 rule
    • Mallampati
    • Obstructions/Obesity
    • Neck mobility
    • Saturation
  248. What is the 3:3:2 rule?
    • 3 finger mouth opening
    • 3 finger chin to hyoid bone
    • 2 finger floor of mouth to thyroid cartilage
  249. What does BOOTS stand for?
    • Beards, beware of full stomach
    • Obesity/obstructions
    • Older patients
    • Toothless
    • Snores/stiff lungs
  250. What does CHANGES stand for?
    • Change blade, smaller tube
    • Help of another provider
    • Alternative airway
    • Neck alignment/release of C-collar
    • Gum-elastic bougie
    • External laryngeal manipulation
    • Suction
  251. What is the LOAD mnemonic used for and what does it stand for?
    • RSI prepatory steps
    • Lidocaine
    • Opiates
    • Atropine for peds
    • Defasiculating dose prior to Sux administration
  252. What are the 7 P's of RSI?
    • Pre-oxygenation
    • Preparation
    • Position
    • Protection and induction
    • Paralysis
    • Placement
    • Proof
  253. What are the primary and secondary causes of bradycardia?
    • Primary is hypoxia
    • Secondary is ICP
  254. What is Hamman's sign?
    • Crunching sound heard with chest auscultation, synchronized with heartbeat
    • Indicates tracheobronchial injury
  255. What are the sxs of tracheobronchial injury?
    • Hamman's sign
    • Persistent hypoxia despite needle decompression
    • Increasing SQ air/crepitus
  256. What is the treatment of tracheobronchial injury?
    Intentional right mainstem intubation below level of injury
  257. What are the most commonly injured areas of the heart in myocardial contusion?
    Right ventricle and right atrium
  258. What are predictable injuries in a rear-end collision?
    • C2 fx Hangman's fx
    • T12-L1 injuries
    • Femur fx
    • Tib/fib fx
    • Ankle fx
  259. What are predictable injuries in a motorcycle side impact or lay-it-down collision?
    • Open femur fx
    • Pelvic fx
    • Trapped arms break ribs
  260. What is a Colles' fracture?
    • Distal radius fx with posterior displacement of the wrist and hand
    • Common in falls
  261. Which is the most common type of hip dislocation?
    • Posterior
    • Extremity flexed and adducted
    • Internal rotation
  262. What is the primary treatment of any fracture?
    Immobilize above and below the injury
  263. What is the formula for CPP?
    CPP = MAP - ICP
  264. What is the formula for MAP?
    MAP = DBP + 1/3 PP
  265. What is cavitation?
    Formation of air bubbles in a liquid at low pressure when the liquid is accelerated
  266. What does TOES stand for and what does it mean?
    • Temporal
    • Occipital
    • Ethmoid
    • Sphenoid
    • Possible bones associated with basilar skull fractures
  267. What is Brudzinski's sign?
    • Nuchal rigidity causes a patient's hips and knees to flex when neck is flexed
    • Can indicate meningitis or subarachnoid hemorrhage
  268. What is Kernig's sign?
    • Inability to straighten the leg when hip is flexed to 90 degrees
    • Indicates meningitis
  269. What is the most severe type of LeFort fracture?
    • Transverse or cranioacial dissociation
    • Involves the zygomatic arch
  270. What are the sxs of subarachnoid hemorrhage?
    • Severe HA
    • vomiting
    • Nuchal rigidity
    • Brudzinski's sign
    • Confusion/ALOC
  271. What artery does an epidural bleed typically involve?
    Middle meningeal
  272. What are some target lab values to maintain an ICP patient at?
    • pCO2 at 35-45, no less than 30
    • Sodium at 155
    • Serum Os <320 mOsm/kg
  273. What is the doll's eyes reflex?
    • Eyes move with head turning
    • Also known as oculocephalic reflex
    • Negative is BAD - eyes remain in mid-position
    • Can indicate brainstem dysfunction
  274. What is Babinski reflex?
    • Initial inflection of great toe in response to stroking of sole
    • Abnormal response is extensor plantar response
    • Can indicate upper motor neuron lesion if abnormal
  275. What is consensual response?
    • Normal pupil will constrict in direct and indirect light
    • No response to either indicate a brain problem
  276. What is autonomic dysreflexia?
    • Massive imbalanced reflex sympathetic discharge which can be caused by fecal impaction or bladder distention
    • Occurs in patients with spinal cord injuries above T6
  277. What cardiac rhythm is common in AC electrical injuries?
    VFib
  278. What cardiac rhythm is common in DC electrical injuries?
    Asystole (D for Dead)
  279. What are the three drugs contained in the cyanide antidote kit?
    • Amyl nitrite
    • Sodium nitrite
    • Sodium thiosulfate
  280. What drug administered for hypertensive emergencies can result in cyanide toxicity?
    Nipride in absence of sufficient thiosulfate
  281. What is the antidote for hydroflouric acid burns?
    Calcium gluconate
  282. What is the hallmark indicator that rhabdomyolysis is occurring in a patient?
    Elevated CK/CPK >20,000
  283. What is hypoxic hypoxia?
    Altitude hypoxia, decrease in alveolar oxygen
  284. What is hypemic hypoxia?
    Decreased oxygen carrying capacity in the blood, anemia
  285. What is histotoxic hypoxia?
    Inability of cells to take up or utilize oxygen, poisoning
  286. What is stagnant hypoxia?
    Decreased cardiac output results in blood pooling, CHF

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