FP-C flashcards.txt

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FP-C flashcards.txt
2014-10-12 10:36:00
FP-C flashcards
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  1. What is normal LAP (left atrial pressure0?
  2. What does RAP stand for?
    Right atrial pressure
  3. What does CVP stand for?
    Central venous pressure
  4. What is normal RAP/CVP range?
    2-6 mmHg
  5. What does a CVP/RAP below 2 indicate?
  6. What does a CVP/RAP above 6 mmHg indicate?
    Fluid overload
  7. What does PAP stand for?
    Pulmonary artery pressure
  8. What is normal (RV/right ventricular pressure) pressure?
    15-25 mmHg
  9. What is the normal pressure for PAP?
    • PAS 15-25mmHg
    • PAD 8-12
  10. What is the A wave in CVP/RAP waveform?
    • Rise in atrial pressure as a result of atrial contraction
    • Normally seen during PR interval before the onset of the QRS on the ECG
  11. What is the C wave in CVP/RAP waveform?
    • Nor alway’s visible
    • rise in the atrial pressure with closure of the AC valves (TM) bulge upward into the atrium following valve closure
  12. What is the V wave in CVP/RAP waveforms?
    • Rise in atrial pressure as it refill during ventricular contraction
    • V-wave is generally seen immediately after the peak of the T wave on the ECG
  13. What is the X wave in the CVP/RAP waveform?
    Decline in right atrial pressure during atrial reaction
  14. What is the Y wave in the CVP/RAP waveform?
    Decline in right atrial pressure; atrial emptying
  15. What does PAD stand for?
    Pulmonary artery diastolic pressure
  16. What is the normal PAD pressure?
    8-12 mmHg
  17. What does PAWP stand for?
    Pulmonary artery wedge pressure
  18. What is the normal PAWP pressure?
    8-12 mmHg
  19. What is the L of normal cardiac output?
  20. How many L/min does cardiac index put out?
    2.5-4.2 L/min
  21. What does a PAWP between 13-14 indicate?
    Acute respiratory distress
  22. What does a PAWP between 15-18 indicate?
    Optimal pressure for CHF
  23. What does a PAWP of above 20, 25 and 30 indicate?
    • 20 is pulmonary congestion
    • 25 is moderat pulmonary congestion
    • 30 is sever pulmonary congestion
  24. What does CI stand for?
    Cardiac index
  25. What is the normal range for cardiac index?
  26. What is normal Systemic vascular resistance?
    800-1200 dyn
  27. What does an SVR below 800CI indicate?
    Distributive shock
  28. What does PVR stand for?
    Pulmonary vascular resistance
  29. What is normal PVR range?
    50-250 dyn
  30. What does PAS stand for?
    Pulmonary Artery systolic pressure
  31. What is PAS normal pressure?
    15-25 mmHg
  32. What is normal ejection fraction?
  33. What is normal CPP?
    Above 60mmHg
  34. What does the Heart sound S1 and S2 indicate?
    Normal sounds with no indication
  35. What does S3 heart sound indicate?
    CHF also called the Kentucky gallup
  36. What does S4 heart sound indicate?
  37. What is the Blue line on the Pulmonary artery catheter?
    The proximal port
  38. What is the yellow line on the Pulmonary Artery Catheter?
    Distal port
  39. What is the Red line on the Pulmonary Artery Catheter?
    Ballon inflation port
  40. What is the max amount of air to inflate the balloon on the Pulmonary artery catheter?
    No more then 1.5cc
  41. What is the clear line on the pulmonary artery catheter?
  42. What pressure are you reading when the Pulmonary Artery Catheter is at the depth of 20cm?
  43. What pressure are you reading when the Pulmonary Artery Catheter is at the depth of 30-35cm
    Means you are in the Right ventricle
  44. What should you do when the you are in the right ventricle?
    Pull back and change infusion to distal from proximal
  45. What is the correct location for the PAC on an X-ray?
    No more then 2cnm below the central helium
  46. What does the Dicrotic notch on the arterial wave form?
    Indicates the closure of the aortic valve
  47. What does the Absence of the A line on the PAWP pressure indicate?
    Hypovolemia or A-fib
  48. What indicates a PA on the ECG?
    inverted T-wave in V3 and isolated ST elevation in V3
  49. What is a Thoracostomy?
    Needle chest decompression
  50. What does APSP/ASYSstand for?
    Assisted systole associated with a balloon pump
  51. What does PSP or SYS stand for?
    Unassisted systole with a balloon pump
  52. What is PAEDP?
    Patient Aortic End diastolic pressure
  53. What does DIA/BIP stand for?
    Unassisted diastole
  54. What does ADIA stand for?
    Assisted diastole
  55. What does BAEDP stand for?
    Balloon aortic end diastolic pressure
  56. When does the Ballon pump know when to trigger?
    • ECG is the primary way,
    • By the R-wave
    • Balloon inflates during diastole
    • Aline DN
  57. What does AUG or PDP stand for?
    Diastole Augmentation
  58. From Left to right state what each wave indicates for the balloon pump starting at the DN.
    • Dn is the closure of the Aortic valve
    • First depression - Unassisted Diastole
    • First peak - Unassisted Systole
    • Second valley - Assisted Diastole
    • Second Peak (Tallest peak) - AUG (Diastolic Augmentation)(peak diastolic pressure)
    • Third Valley, last before recycle. Assisted Diastole
    • Third peak, last before recycle. Assisted Systole
  59. How to do you determine early inflation of the ballon pump?
    Draw a line from the DN back to the first valley, if the middle valley is greater the 2mm above, it is early
  60. How do you determine later inflation of the balloon pump?
    Draw a line from the first valley to the final valley, if at or above it is late.
  61. How many beats for how many seconds indicates a good acceleration for FHR?
    • <32 weeks gestation = 10x10 accelerations
    • > Weeks gestation = 15 x 15 accelerations
  62. When should accelerations for FHR occur?
    Durring the mothers contrition
  63. What are Variable decelerations?
    Decelerations in FHR that occur anywhere during contraction
  64. What does Variable decelerations indicate?
    Cord problems
  65. What are early Decelerations?
    Decelerations in FHR, they mirror contractions
  66. What do early decelerations indicate?
    Head compression
  67. What are late decelerations?
    Decelerations in FHR that occur at the peak of contraction
  68. What do late decelerations indicate?
    Uteroplacental insufficiency
  69. What is a Sinusoidal pattern for FHR?
    Smooth wave like line
  70. What does Sinusoidal pattern indicate?
    Fetal Anemia/shock
  71. What is a Pseudosinusoidal Pattern for FHR?
    Irregular waves
  72. What does Pseudosinusoidal indicate?
    The administration of narcotics to mother, high baby
  73. What is normal pH?
    7.35 - 7.45
  74. What is normal arterial oxygen partial pressure?
  75. What is Henry’s law?
    Gas Law, At a constant temperature, the amount of a given gas that dissolves in a given type and volume of liquid is directly proportional to the partial pressure of that gas in equilibrium with that liquid
  76. What is Boyle’s Law?
    The absolute pressure exerted by a given mass of an ideal gas is inversely proportional to the volume it occupies id the temperature and amount of gas remain unchanged within a closed system
  77. What is Charles Law?
    When the pressure on a sample of a dry gas is held constant, the kelvin temperature and the volume will be directly related
  78. What is Gay-Lussac’s law?
    • The law of combining volumes
    • When gases react together to form other gases, and all volumes are measured at the same temperature and pressure; the Ratio between the volumes of the reactant gases and the products can be expressed in simple whole numbers
  79. What is the normal HCO3 arterial?
  80. What is the normal pCO2 ABG?
  81. What is normal pO2 Arterial?
  82. What is the normal Hemoglobin value for a male ?
  83. What is the normal Hematocrit for a male?
  84. What is the normal Creatinine levels?
  85. What is the normal potassium level?
    3.5-5.2 mEq/L
  86. What is the normal Na+ level?
    135-147 mEq/L
  87. What is the normal lactic acid level?
    0.7-2.1 mEq/L
  88. What are normal HDL cholesterol levels?
    > 35mg/dL
  89. What are normal LDL cholesterol levels?
  90. What does a decreased CVP/RAP indicate?
    • Hypovolemia
    • Vasodilation
    • Decreased preload
    • Negative pressure ventilation
  91. What does an elevated CVP/RAP indicate?
    • Hypervolemia
    • Right sided heart failure
    • Cardiac tamponade
    • Positive pressure ventilation
    • COPD
    • Pulmonary HTN
    • PE
    • Pulmonic stenosis
    • Tricuspid regurgitation
  92. What does an elevated RVP elevated?
    • Pulmonary HTN
    • COPD
    • PE
  93. What does an elevated PAP (PAS/PAD) indicate?
    • Fluid overload
    • Atrial or ventricular defect
    • Pulmonary disease
    • LV failure
    • Mitral stenosis
    • Mitral regurgitation
  94. What does a low PAWP indicate?
    • Hypovolemia
    • Venodilation drugs
  95. What does an elevated PAWP indicate?
    • LV failure
    • Constrictive pericarditis
    • Mitral stenosis
    • Mitral regerg
    • Fluid overload
    • Renal failure
  96. What does an elevated PVR indicate?
    • Pulmonary disease
    • Hypoxia
  97. What does a low SVR indicate?
    • Septic shock
    • Neuro shock
    • Anaphylactic shock
    • Vasodilators
  98. What does an elevated SVR indicate?
    • Hypovolemic shock
    • Cardiogenic shock
    • R MI
    • Aortic stenosis
    • Vasoconstrictors
  99. What do you expect in for CVP, CI, Wedge and SVR for hypovolemic shock?
    • CVP - low
    • CI - Low
    • PAWP - Low
    • SVR - High
  100. What do you expect in for CVP, CI, Wedge and SVR for Cardiogenic shock?
    • CVP - High
    • CI - Low
    • PAWP - High
    • SVR - High
  101. What do you expect in for CVP, CI, Wedge and SVR for RVMI shock?
    • CVP - High
    • CI - Low
    • PAWP - Low
    • SVR - High
  102. What do you expect in for CVP, CI, Wedge and SVR for Septic shock?
    • CVP -
    • CI - High
    • PAWP -
    • SVR - Low
  103. What do you expect in for CVP, CI, Wedge and SVR for Neurogenic shock?
    • CVP -
    • CI - Low
    • PAWP -
    • SVR -
  104. What do you expect in for CVP, CI, Wedge and SVR for Anaphylactic shock?
    • CVP -
    • CI - Low
    • PAWP -
    • SVR - Low
  105. With an SVR of <800 what kind of shock is of highest suspicion?
    • Distributive or Vasodilatory shock
    • - Distributive shocks like Septic, Neurogenic or anaphylactic shock.
  106. After discovering an SVR 800> what to look at next to distinguish between distributive shocks?
    • CI -
    • High for Septic,
    • Low for Neuogenic and Anaphylactic
  107. After discovering that the SVR is 800> and the CI is low, how do you determine the difference between Anaphylactiv shock and Neurogenic shock?
    • In Neurogenic shock the the Heart rate will be normal or slow
    • for anaphylactic shock the HR will be fast
  108. With an SVR >1200 what types of shock are of highest suspicion?
    • Hypovolemia
    • Cardiogenic
    • RVMI
  109. After finding an SVR >1200 how do you determine the difference betweenHypovolemia, Cardiogenci and RVMI shocks?
    • Look at CVP and PAWP
    • Hypo - CVP is low (no wedge needed)
    • Cario - CVP High/Wedge High
    • RVMI - CVP High/Wedge low
  110. After finding an SVR >1200 and a Low CVP what type of shock is it?
  111. After finding an SVR >1200 and a High CVP what type of shock(s) is it?
    • Cardiogenic or RVMI
    • Look at PAWP to distinguish
    • Cardio high PAWP
    • RVMI low PAWP
  112. What is the Formula for CPP?
    DBP - PAWP
  113. What is the formula for MAP?
    2 x DBP + SBR / 3
  114. What is normal MAP?
  115. What is the Allen’s test?
    Blanch test to insure adequate perfusion to the radial and ulnar prior to Arterial line insertion
  116. What does the PA actually Monitor?
    Reflect right and left sided heart pressures
  117. What does the PAWP actually monitor?
    Pressure of the left side of the heart (Preload)
  118. What is Cardiac index?
    Body surface area and is more accurate, access blood blow
  119. What are the types of Hypoxia?
    • Hypoxic hypoxia (altitude hypoxia)
    • Hypemic hypoxia
    • Stagnant hypoxia
    • Histotoxic hypoxia (Tissue poisoning)
  120. What is Hypoxic Hypoxia?
    • Altitude Hypoxia
    • Is a deficiency in the alveolar oxygen exchange, which can be caused by low barometric pressure
  121. What is Hypemic hypoxia?
    A reduction in the oxygen-carrying capacity of the blood
  122. What is Stagnant Hypoxia?
    When conditions exist that result in reduced total cardiac output, pooling of the blood within certain regions of the body, a decreased blood flow to the tissue, or restriction of blood flow
  123. What is Histotoxic hypoxia?
    • Tissue poisoning
    • Occurs when metabolic disorders or poisoning of the cytochromic oxidase enzyme results in a cells inability to use molecular oxygen
  124. What are the inferior wall leads?
    • II
    • II
    • aVF
  125. What are the Reciprocal inferior leads?
    • I
    • aVL
    • V1-V4
  126. What are the Anterior-septal leads?
  127. What are the reciprocal Anterior-septal leads?
    • II
    • III
    • aVF
    • aVL
  128. What are the Lateral wall leads?
    • I
    • aVL
    • V5
    • V6
  129. What are the reciprocal lateral leads?
    • II
    • III
    • aVF
  130. What are the posterior wall leads?
  131. What are the reciprocal posterior leads?
  132. What is the normal Troponin I range?
    0.01 ng/mL
  133. What is the onset of Troponin?
    4-6hrs, peaks in 12-24hrs
  134. What is the normal Troponin T range?
    0-0.02 ng/mL
  135. What is the onset of Troponin T?
    • 3-4hrs
    • Peaks in 10-24hrs
  136. What is Dressler’s syndrome?
    • A secondary form of pericarditis that occurs in the setting of injury to the heart or pericardium
    • Also known as post MI syndrome
  137. What is a Pericardial effusion
    The development of pericardial fluid as response to injury, acute pericarditits. Electrical alternanes can be present
  138. What does Grave’s disease indicate?
  139. What does Myxedema indicate?
  140. What does Addisons disease indicate?
    Acute renal insufficiency
  141. What does Cushings disease indicate?
  142. What is the Levine’s sign and what may it indicate?
    • Clutching of the chest
    • May indicate cardiac problem
  143. What is the murphy’s sign and what may it indicate?
    • Right upper quadrant pain
    • May indicate gallbladder disease
  144. What is Grey turner’s sign and what may it indicate?
    • Retroperitoneal bruising
    • May indicate pancreatitis or trauma
  145. What is Cullens sign and what may it indicate?
    • Periumbilical bruising
    • May indicate pancreatitis or intra-abdominal bleeding
  146. What is Halstead sign and what may it indicate?
    • Marbled appearance of the abdomen
    • May indicate necrosis of the pancreas
  147. What is Kehr’s sign and what may it indicate?
    • Shoulder pain
    • May indicate spleen injury on the left side or ectopic pregnancy/rupture on either side
  148. What is Hamman’s sign and what may it indicate?
    • Crunching sound heard with auscultation
    • May be synchronized with heart rate/pulse
    • May indicate a tracheobronchial injury
  149. What is Orhopnea?
    Increased SOB in supine/lying position and is relieved by sitting and or standing
  150. What is Paroxysmal nocturnal dyspnea?
    • Also known as cardia asthma
    • A sudden, severe SOB at night that awakens a person from sleep often with coughing and wheezing.
    • Closely related to CHF (not immediate upon lying down)
  151. What is Dilated Cardiomyopathy?
    • Ventricular dilation
    • Contractile dysfunction
    • SXS of heart failure
  152. What is Hypertropic cardiomyopathy?
    • Inappropirate LVH with preserved or enhances contractile function
    • Systolic murmur can be present
    • Etiology unclear
  153. What is Restrictive Cardiomyopathy?
    • Least common of the Cardiamyopathies
    • Endocardial scarring of the ventricle with impaired diastolic filling
  154. What is Cardiomegaly?
    A medical condition wherein the heart is enlarged
  155. What is Diabetic Ketoacidosis (DKA)?
    • Problem is lacking or low insulin
    • Usually can develop at any age and is most likely to occur in an insulin dependent patient
    • Acidosis is present
    • Usually BGL less the 1000mg/dL
  156. What is Hyperglycemic hyperosmolar nonKetotic coma (HHNK)?
    • High sugar with high serum osmolarity
    • Most pts are older with other underlying disease and experience sudden sever neurologic changes
    • Usually no production of ketones or presence of acidosis
    • Usually BGL is >1000mg/dL
  157. What is Hepatic encephalopathy?
    • Occurrence of confusion, ALC and coma due to liver failure
    • Caused by accumulation of toxic substances in the blood that are normal removed by the liver.
  158. What is the normal Ammonia range?
    • 15-45 ug adult
    • 40-80 ug Peds
    • Test liver function
  159. What is normal Albumin range?
    • Adult: 3.4-5.4 g/dL
    • Peds: 3.0-5.0 g/dL
    • Test liver function
    • Decreased during gestation
  160. What is the normal Alkaline phosphatase range?
    • Male: 98-251 U/L
    • Female: 81-196 U/L
    • Test liver function but found in biliary tract, bone, intestine and placenta
  161. What is normal Immunoglobins range?
    • IgA: 140-400mg/dL
    • IgD: 0-8mg/dL
    • IgG: 700-1500 mg/dL
    • IgM: 35-375 mg/Dl
  162. What does an elevated IgA, IgD, IgG or IgM indicate
    • IgA - Chronic liver disease
    • IgD - Chronic infections and liver disease
    • IgG - Autoimmune hepatits, leannecs cirrhosis
    • IgM - Biliary cirrhosis, hepatitis and viral infections
  163. What is normal Prothrombin time?
    • Male: 9.6-11.8sec
    • Female 9.5-11.3 sec
    • Peds 11-14 sec
    • Neonate: 12-21sec
  164. What is Prothrombin?
    • A vitamin K dependent protein produced by the liver.
    • Can be used to assess liver function
  165. What is normal Platelet range?
    • Adult: 150,000 - 450,000
    • Ped: 170,000- 380,00
    • Can be used to assess liver function
  166. What is normal Alanine Aminotransferase range?
    • Male: 7-46 U/mL
    • Females: 5-35 U/mL
    • Peds: 3-37 U/L
  167. What is Alanine Aminotransferase?
    • An enzyme produced by the liver that acts as a catalyst in amine acid production.
    • can be used to assess liver function
  168. What is Aspertate Aminotransferase range?
    • Male: 8-26 U/L
    • Female: 8-20 U/L
    • Peds: 19-28
  169. What is Aspertate Aminotransferase?
    • An enzyme that catalyzes the reversible transfer of an amino between the amino acid.
    • Can be used to assess liver function
  170. What is Gamma-glutamyl range?
    • Male: 10-39 IU/L
    • Female : 6-29 IU/L
    • Peds: 0-23 IU/L
  171. What is Gammaglutamyl?
    • GGT or GGTP
    • Enzyme that participates in the transfer of amino acids and peptides across cellular membranes.
    • Can be uses to assess liver function
  172. What is Bilirubin range?
    Adult: Indirect Bili 0.3-1.1 mg/dL, Direct Bili 0.1-0.4 mg/dL
  173. What is Bilirubin?
    • Degradation product of the pigmented heme portion of hemoglobin
    • Can be used to assess liver function
  174. What is Diabetes insipidus?
    • Condition where the kidneys are able to conserve water
    • Hence the phrase “peeing like a racehorse
  175. What is Syndrome of inappropriate antidiuretic hormone (SIADH)?
    Occurs when excessive levels of ADH (arginine, vasopressine, AVP) are reduced which causes the body to retain water
  176. What are the SxS of Diabetes insipidus?
    Excessive thirst and excretion of large amounts of severely diluted urine
  177. What are the SxS of SIADH?
    • Weight gain
    • nausea
    • vomiting
    • altered mentation
    • irritability and seizures
  178. What is the normal range of Hemoglobin?
  179. What is the normal range of Hematacrit?
  180. What is the significance of Hemoglobin?
    Amenia, indicated hemorrhage, lead poison, sick cells and many other possible issues
  181. What is the significance of Hematacrit?
    High in COPD patients and low in dehydrated or hemorrhage
  182. What is normal WBC range?
  183. What is the significance of WBC levels?
    • Increases with infection and is known as leukocytosis
    • A decrease is called leucopnia
  184. What is normal Na+ range?
  185. What is normal potassium levels?
  186. What is normal Ca+ levels?
  187. What are normal Chloride ranges?
  188. What is normal CO2 levels?
  189. What is the normal BUN range?
  190. What is the normal Creatinine range?
  191. What is the significance of BUN levels?
    May indicate blood in the gut, dehydration or renal failure
  192. What is the significance of Creatinine levels?
    >1.4 may indicate renal failure
  193. What is the normal Serum OS range?
  194. What is the normal range for Magnesium levels?
  195. What does a pCO2 <35 cause?
    High pH, Alkalosis
  196. What does a pCO2 of >45 cause?
    Acidosis, low pH
  197. How to disguise between Acute and chronic respiratory acidosis
    • Acute respiratory acidosis- For q 10 increase of pCO2, there is a decrease of pH by 0.08 and/or an increase of HCO3 by 1
    • Chronic Respiratory Acidosis- For q 10 increase of pCO2, there is a decrease of pH by 0.03 and/or an increase of HCO3 by 3
  198. How to distinguish between acute and chronic respiratory alkalosis.
    • Acute Respiratory Alkalosis - for q 10 increase of pCO2, there is an increase of pH by 0.08 and/or a decrease of HCO3 by 2
    • Chronic respiratory alkalosis - for q 10 increase of pCO2, there is an increase of pH by 0.3 and/or a decrease of HCO3 by 5
  199. Range for HCO3 and causes of > and <.
    • 22-26
    • <22 acidosis
    • >26 Alkalosis
  200. What is the formula for the anion gap (AG)?
    AG= NA - (Cl + HCO3)
  201. What is the normal range of AG?
  202. What are the rules to determine respiratory or metabolic acidosis and alkalosis?
    • Rule 1: Evaluate the pH
    • Rule 2: Evaluate the pCO2. Is it acute or chronic for respiratory disorder?
    • Rule 3: Evaluate HCO3 and calculate anion gap (AG) for primary metabolic disorder and/or delta gap is metabolic acidosis is present
    • Rule 4: Identify the primary acid-base disorder
    • Rule 5: Determine if compensation is present
  203. What do you expect to fin in pH, pCO2 and HCO3 in Respiratory acidosis?
    • Low pH
    • High pCO2
    • High HCO3 (compensatory response)
  204. What do you expect to fin in pH, pCO2 and HCO3 in Respiratory alkalosis?
    • High pH
    • Low pCO2
    • Low HCO3 (Compensatory response)
  205. What do you expect to fin in pH, pCO2 and HCO3 in Metabolic acidosis?
    • Low pH
    • Low HCO3
    • Low pCO2 (compensatory response)
  206. What do you expect to fin in pH, pCO2 and HCO3 in Metabolic Alkalosis?
    • High pH
    • High HCO3
    • High pCO2 (Compensatory response)
  207. What is normal Tidal Volume?
    Initial is 508mL/kg
  208. Mechanical ventilator troubleshooting, High pressure. Cause, intervention.
    • Cause: Resistance to ventilation is high. This may occur secondary to deuced ling elasticity or airway obstruction or extrinsic compression
    • Intervention: Tube suctioning and adequate patient sedation are recommended after other causes of obstruction are ruled out.
  209. Mechanical ventilator troubleshooting, Low exhaled volume. Cause, intervention?
    • Cause: Air leaks, these are the most frequently secondary to ventilatory tubing disconnection from the patient’s tracheal tube but can also occur in the event of balloon deflation or tracheal tube dislodgment.
    • Intervention: Tube placement, balloon inflation, amount go oxygen in tank and connection to the ventilator should be carefully verified.
  210. Mechanical ventilator troubleshooting, Hypoxia. Cause, intervention?
    • Cause: Secondary to hypoventilation, worsening cardiac shunting, inadequate FIO2, mainstem intubation, aspiration, tube dislodge or pulmonary edema.
    • Intervention: Increase FIO2 and adjusting ventilatory setting to increase PEEP or respiratory rate are useful first steps after excluding equipment failure and mechanical causes of hypoxia
  211. Mechanical ventilator troubleshooting, Hypotension. Cause, intervention?
    • Cause: Hypotension after intubation can be caused by diminished central venous blood return to the heart secondary to elevated intrathoracic pressures. Hypotension may also be secondary to vasovagal reaction to intubation, rapid sequence induction, sedation, and tension pneumonothoraz.
    • Intervention: This can be treated with fluid infusion and /or adjustment of ventilatory setting to lower intrathoracic pressure (reducing PEEP, tidal volume, and , if air trapping is suspected, respiratory rate)
  212. What is a Noncompetitive depolarizing Neuromuscular blocking agent (NMBAs)?
    Succinylcholine (anectine)
  213. What is the action of Succinylcholine (anectine)?
    Binds with the motor-end plate and causes a continuous depolarization, which results in fasciculation
  214. What is the result of Succinylcholine (anectine)?
    Unresponsive to acetylcholine causing paralysis
  215. What are the advantages of Succinylcholine (anectine)?
    Short onset of action of less than 1 min and ultra short-acting duration of 4-6min
  216. what are the disadvantages of Succinylcholine (anectine)?
    Potential complications include hyperkalemia, bradycardia, especially in pediatric patients, bronchospasm
  217. What are some examples of Competitive nondepolarizing Neuromuscular blocking agents?
    • Rocuronium (Zemuron),
    • Vecuronium (norcuron),
    • Pancuronium (pavulon)
  218. What is the action at receptor sites of Rocuronium (Zemuron), Vecuronium (norcuron), Pancuronium (pavulon)?
    Competitively binds with the motor-end plate and does not caused depolarization
  219. What is the result of Rocuronium (Zemuron), Vecuronium (norcuron), Pancuronium (pavulon)?
    Blocks acetylcholine causing paralysis
  220. What are the advantages of Rocuronium (Zemuron), Vecuronium (norcuron), Pancuronium (pavulon)?
    Used to extend the time of neuromuscular blockade after intubation
  221. What are the disadvantages of Rocuronium (Zemuron), Vecuronium (norcuron), Pancuronium (pavulon)?
    Longer onset of action and duration
  222. What is the COPD Triad
    • Asthma
    • Chronic bronchitis
    • Emphysema
  223. What is Anterior cord syndrome?
    Blood supply to the anterior portion of the spinal cord is interrupted, causing a complete motor paralysis below the level of the lesion due to interruption of the corticospinal tract. Loss of pain and temperature sensation at and below the level of the lesion due to interruption of the spinothalamic tract. Most commonly occurs after hyperflexion injury
  224. What is the brown Sequard syndrome?
    Any presentation of spinal injury that is an incomplete lesion can be called a partial Brown-Sequard or incomplete Brown-Sequard syndrome, so long as it is characterized by features of a motor loss and numbness to touch and vibration on the some side of the spinal injury and loss of pain and temperature sensation on the opposite side. Most often occurs from a penetrating injury that has damaged one side of the spinal cord
  225. What is the central cord syndrome?
    It is characterized by disproportionately greater motor impairment in upper compared to lower extremities and variable degree of sensory loss below the level of the injury. Most often occurs after hyperextension injury.
  226. What is the Parkland Burn Formula?
    [(4mL x kg) x % of TBSA]
  227. What is the Modified Brooke Formula?
    • For burns
    • [(2mL x kg) x % TBSA]
  228. What is the Consensus Formula?
    • For burns
    • Combined Parkland and Brooke
    • (2-4mL x kg)/ % TBSA
  229. What are the common clinical findings of Hypovolemic shock?
    • Rapid, weak, thready pulse due to decreased blood flow combined with tachycardia; cool, clammy skin due to vasoconstriction and stimulation of vasoconstriction; Increased thirst, altered mentation and hypotension
    • SVR >1200
    • low CVP
  230. What are the common clinical findings of Cardiogenic shock?
    • Distended jugular veins due to increased jugular venous pressure; crackled; weak or absent distal pulses; hypotension and arrhythmias, ofter tachycardia
    • SVR >1200
    • CVP high
    • PAWP high
  231. What are the clinical findings of Neurogenic shock?
    • Hypotension; may be accompanied by profound bradycardia due to loss of the cardiac accelerating nerve fibers from the sympathetic nervous system at T1-T4. The skin is warm and dry or clear west lines exists, above which the skin is diaphoretic; priapism due to peripheral nervous system stimulation
    • SVR <800
    • CI low
    • HR normal or brady.