AAS CCT TEST.txt

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AAS CCT TEST.txt
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2014-12-15 21:31:28
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AAS critical care flashcards
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  1. What is the Premedicate medication for RSI?
    Lidocaine 1.5mg/kg IV for head injury or asthma
  2. What are the medications for sedation in RSI?
    • Etomidate or Midazolam
    • Ketamine
  3. What is the dose for Etomidate in RSI?
    • 0.3mg/kg IV
    • Use cation in septic shock
    • Consider alternative sedation for suppleental corticosteroids
  4. What is the dosing for Midazolam in RSI?
    • 0.1mg/kg IV (adults)
    • 0.3mg/kg IV (Peds)
  5. What is the dosing of Ketamine?
    • 1-2 mg/kg IV (Bronchodilator)
    • Raises intracranial pressure
    • Avoid in Head Injury
  6. What Paralytic should be used in RSI?
    • Succinylcholine
    • Vecuronium
    • Rocuronium
  7. What is the dosing of succinylcholine in RSI?
    • 2mg/kg IV
    • Avoid in hyperkalemia, neuromuscular disease or ocular trauma
  8. What is the dosing for Vecuronium in RSI?
    0.1mg/kg IV
  9. What is the dosing for Rocuronium in RSI?
    • 1mg/kg IV
    • Wait for relaxation 45-60 sec) Do not bag unless hypoxic
  10. What drug and dosing should be used post RSI for sedation?
    • Midazolam 0.05 mg/kg to 0.3mg/kg
    • Suggestive maximum dose 10mg; reduce dose or consider alternative hypotension or elderly
  11. What drug and dosing should be used post RSI to maintain paralysis?
    Vecuronium 0.1 mg/kg IV (If not used for intubation)
  12. What drug and dosing should be used post RSI for Analgesia?
    • Fentanyl 1-2 mcg/kg IV
    • or
    • Morphoine 0.05 to 0.15 mg/kg IV
    • Consider need for seizure prevention
  13. What is the AAS medication guideline for sedation of intubated pts?
    • Analgesia Fen 1-3mcg/kg
    • Sedation Versed 0.05mg/kg or Ativan 0.05 mg/kg
  14. What pH and PaCO2 do in respiratory acidosis?
    • pH low
    • PaCO2 high
  15. What will pH and PaCO2 do in Metabolic acidosis?
    • pH low
    • PaCO2 low
  16. What will pH and PaCO2 do in Respiratory Alkalosis?
    • pH high
    • PaCO2 low
  17. What will pH and PaCO2 do in Metabolic Alkalosis?
    • pH high
    • PaCO2 high
  18. What is the normal anion gap?
    12+-2
  19. What does HCO3 do in Metabolic acidosis?
    HCO3 is low
  20. What does HCO3 do in Metabolic alkalosis?
    HCO3 High
  21. What does HCO3 do in Metabolic Acidosis?
    High concentration
  22. What does HCO3 do in Respiratory acidosis?
    Low
  23. What is the primary problem and compensation in Metabolic Acidosis?
    • Primary - Low HCO3
    • Compensation - Low PaCO2
  24. What is the primary problem and compensation in Metabolic Alkalosis?
    • Primary - High HCO3
    • Compensation - High PaCO2
  25. What is the primary problem and compensation in Respiratory acidosis?
    • Primary - High PaCO2
    • Compensation - High HCO 3
  26. What is the primary problem and compensation in Respiratory Alkalosis?
    • Primary - PaCO2
    • Compensation - Low HCO3
  27. What is normal value of Central Venous pressure (CVP)?
    2-6 mmHg
  28. What is the normal value of Right Ventricular Pressure (RV)?
    • SBP 15-25 mmHg
    • DBP 0-5 mmHg
  29. What is normal Pulmonary Artery pressure?
    • PAS 15-25 mmHg
    • PAD 8-12 mmHg
  30. What is normal PAWP?
    8-12
  31. What is the normal HCO3 arterial?
    19-25
  32. What is the normal pCO2 ABG?
    35-45
  33. What is normal pO2 Arterial?
    70-100
  34. What is the normal Hemoglobin value for a male ?
    13.5-16.5
  35. What is the normal Hematocrit for a male?
    41-50
  36. What is the normal Creatinine levels?
    0.5-1.4
  37. What is the normal potassium level?
    3.5-5.2 mEq/L
  38. What is the normal Na+ level?
    135-147 mEq/L
  39. What is the normal lactic acid level?
    0.7-2.1 mEq/L
  40. What are normal HDL cholesterol levels?
    > 35mg/dL
  41. What are normal LDL cholesterol levels?
    65-180mg/dL
  42. What do you expect in for CVP, CI, Wedge and SVR for hypovolemic shock?
    • CVP - low
    • CI - Low
    • PAWP - Low
    • SVR - High
  43. What do you expect in for CVP, CI, Wedge and SVR for Cardiogenic shock?
    • CVP - High
    • CI - Low
    • PAWP - High
    • SVR - High
  44. What do you expect in for CVP, CI, Wedge and SVR for RVMI shock?
    • CVP - High
    • CI - Low
    • PAWP - Low
    • SVR - High
  45. What do you expect in for CVP, CI, Wedge and SVR for Septic shock?
    • CVP -
    • CI - High
    • PAWP -
    • SVR - Low
  46. What do you expect in for CVP, CI, Wedge and SVR for Neurogenic shock?
    • CVP -
    • CI - Low
    • PAWP -
    • SVR -
  47. What do you expect in for CVP, CI, Wedge and SVR for Anaphylactic shock?
    • CVP -
    • CI - Low
    • PAWP -
    • SVR - Low
  48. 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
  49. With an SVR >1200 what types of shock are of highest suspicion?
    • Hypovolemia
    • Cardiogenic
    • RVMI
  50. 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
  51. After finding an SVR >1200 and a Low CVP what type of shock is it?
    Hypovolemic
  52. 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
  53. What is the Formula for CPP?
    DBP - PAWP
  54. What is the normal Troponin I range?
    0.01 ng/mL
  55. What is the onset of Troponin?
    4-6hrs, peaks in 12-24hrs
  56. What is the normal Troponin T range?
    0-0.02 ng/mL
  57. What is the onset of Troponin T?
    • 3-4hrs
    • Peaks in 10-24hrs
  58. What is the normal Ammonia range?
    • 15-45 ug adult
    • 40-80 ug Peds
    • Test liver function
  59. 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
  60. 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
  61. What is normal Immunoglobins range?
    • IgA: 140-400mg/dL
    • IgD: 0-8mg/dL
    • IgG: 700-1500 mg/dL
    • IgM: 35-375 mg/Dl
  62. 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
  63. What is normal Prothrombin time?
    • Male: 9.6-11.8sec
    • Female 9.5-11.3 sec
    • Peds 11-14 sec
    • Neonate: 12-21sec
  64. What is Prothrombin?
    • A vitamin K dependent protein produced by the liver.
    • Can be used to assess liver function
  65. What is normal Platelet range?
    • Adult: 150,000 - 450,000
    • Ped: 170,000- 380,00
    • Can be used to assess liver function
  66. What is normal Alanine Aminotransferase range?
    • Male: 7-46 U/mL
    • Females: 5-35 U/mL
    • Peds: 3-37 U/L
  67. 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
  68. What is Aspertate Aminotransferase range?
    • Male: 8-26 U/L
    • Female: 8-20 U/L
    • Peds: 19-28
  69. 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
  70. What is Gamma-glutamyl range?
    • Male: 10-39 IU/L
    • Female : 6-29 IU/L
    • Peds: 0-23 IU/L
  71. 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
  72. What is Bilirubin range?
    Adult: Indirect Bili 0.3-1.1 mg/dL, Direct Bili 0.1-0.4 mg/dL
  73. What is Bilirubin?
    • Degradation product of the pigmented heme portion of hemoglobin
    • Can be used to assess liver function
  74. What is the normal range of Hemoglobin?
    12-18
  75. What is the normal range of Hematacrit?
    36-52%
  76. What is normal WBC range?
    4.5-10.5
  77. What is the significance of WBC levels?
    • Increases with infection and is known as leukocytosis
    • A decrease is called leucopnia
  78. What is normal Na+ range?
    135-145
  79. What is normal potassium levels?
    3.5-5.5
  80. What is normal Ca+ levels?
    8.8-10.4
  81. What are normal Chloride ranges?
    95-112
  82. What is normal CO2 levels?
    24-30
  83. What is the normal BUN range?
    6-23
  84. What is the normal Creatinine range?
    0.6-1.4
  85. What is the significance of BUN levels?
    May indicate blood in the gut, dehydration or renal failure
  86. What is the significance of Creatinine levels?
    >1.4 may indicate renal failure
  87. What is the normal Serum OS range?
    285-295
  88. What is the normal range for Magnesium levels?
    1.5-2.5
  89. Range for HCO3 and causes of > and <.
    • 22-26
    • <22 acidosis
    • >26 Alkalosis
  90. What is the formula for the anion gap (AG)?
    AG= NA - (Cl + HCO3)
  91. What is the normal range of AG?
    12+4
  92. What do you expect to fin in pH, pCO2 and HCO3 in Respiratory acidosis?
    • Low pH
    • High pCO2
    • High HCO3 (compensatory response)
  93. What do you expect to fin in pH, pCO2 and HCO3 in Respiratory alkalosis?
    • High pH
    • Low pCO2
    • Low HCO3 (Compensatory response)
  94. What do you expect to fin in pH, pCO2 and HCO3 in Metabolic acidosis?
    • Low pH
    • Low HCO3
    • Low pCO2 (compensatory response)
  95. What do you expect to fin in pH, pCO2 and HCO3 in Metabolic Alkalosis?
    • High pH
    • High HCO3
    • High pCO2 (Compensatory response)
  96. What is normal Tidal Volume?
    Initial is 508mL/kg
  97. What does Vt stand for?
    Tidal volume
  98. What is the setting of total volume?
    • 6-8cc/kg
    • Start at 8 go to 6
    • Base it on IDEAL body weight
  99. When do you change the tidal volume?
    • Vt = Protection
    • ONLY CHANGE FOR PROTECTION
    • DO NOT CHANGE TO ADJUST END TITAL
  100. What is IFR?
    • Inspiratory flow rate
    • How fast the breath goes in
    • High is fast, low is slow
  101. What is the range setting for IFR?
    • 60-80 LPM
    • Higher is more common
  102. What does IFR =?
    Comfort
  103. What is the formula for an intubated pt for the needed cc/min ventilation?
    • 120 mL/kg/min
    • divide by the Vt and gives breath/min
    • 16-18 if needed
    • 18 is start then go from there
  104. What does RR=?
    Ventilation
  105. What do you get PEEP and FiO2 at?
    • Goal is to maintain 88-95% Saturation.
    • Both go in tandem.
    • As FiO2 goes up PEEP goes up.
    • Titrate to 90%
  106. What do you start PEEP at?
    • 5 and adjust based on Saturation with 40% oxygen
    • Use PEEP scale for tandem of FiO2 settings
  107. If Saturation is low what do you do?
    • Increase one notch on PEEP to 8
    • Can increase Saturation also
  108. If saturation is higher then 95% how do you adjust PEEP?
    Decrease PEEP
  109. FiO2/PEEP=?
    Oxygenation
  110. Plateau pressure?
    Its what the alveoli are actually receiving in pressure
  111. What do you want the plateau pressure at?
    Less then 30 cm/H2O
  112. What do you do if the Plateau pressure is greater then 30?
    Decrease Vt
  113. If CO2 is too high what do you adjust on the Ventilator?
    Increase RR
  114. If CO2 is too low what do you adjust on Vent?
    Decrease RR

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