Air Methods Critical Care exam with complete solutions

What is the most reliable method of confirming and montioring correct placement of an ET tube? - Answer- Continuous waveform capnography The upper airway consists of... - Answer- Nose, Mouth, Jaw, Oral Cavity, Pharynx, and Larynx No gas exchange occurs here __________, it's called ____________. - Answer- Nose to terminal bronchioles, anatomical dead space. (2ml/kg of inspired tidal volume) They conduct airflow towards gas exchange units. Crycothyroid membrane - Answer- between thyroid and cricoid, avascular structure that connects the thyroid and cricoid cartilage. Site of CRiCOTHYROTOMY- an emergency opening of the airway. A PaCO2 greater than 45 mmHg indicates: A. Metabolic acidosis. B. Metabolic alkalosis. C. Respiratory acidosis. D. Respiratory alkalosis. - Answer- C. Respiratory acidosis PaCO2 normal range - Answer- 35-45 mm Hg Less than 35 likely means hyperventilation Tracheal deviation AWAY from the affected side, decreased breath sounds, and hyperresonance... What's happening? - Answer- Tension pneumothorax In a tension pneumothorax tracheal deviation goes in what direction? - Answer- AWAY from affected side. Normal mean pulmonary artery pressure - Answer- 10-20 mmHg Pulmonary hypertension is a mean PA pressure greater than... - Answer- (PAm) greater than 20 Primary pulmonary hypertension - Answer- Idiopathic genetic disorder caused by abnormal structure of the pulmonary blood vessels Name three causes of secondary pulmonary hypertension.. - Answer- 1. Passive PH- the result of back pressure. Mitral Stenosis, LV systolic failure. 2. Active PH- Constriction of the pulmonary circuit Increased volume in pulmonary circuit (i.e. congenital heart disease) 3. Obstruction as in Chronic recurrent PE TNP of the Pregnant patient - Answer- Resuscitation priorities are the same. The best way to take care of the baby is to take care of mama Mechanisms of injury and biomechanics the most common cause of maternal injury is... - Answer- Blunt trauma caused by MVC. Second is BT caused by falls, 3rd is violence fetal distress is an early sign of maternal distress... Why? - Answer- Catecholamine mediated vasoconstriction resulting from blood loss shunts blood away from the fetus to the mom. Fetal hypo perfusion is evidenced by.... - Answer- Fetal tachycardia (140 to 160+) and fetal bradycardia The FRC in a pregnant patient is.... - Answer- Reduced by the gravid uterus lifting the diaphragm. chest tube placement in a pregnant patient is 1-2 spaces higher - Answer- Because of the lifted diaphragm What is the cause of physiological anemia in pregnant patients? - Answer- Hemodilitional anemia occurs. Plasma volume increases 30-50%. Preterm Labor (PTL) - Answer- abruptio placentae - Answer- premature separation of the placenta from the uterine wall On a pregnant patient... - Answer- Chest compressions must be higher on the sternum. Any preg patient 20 weeks pregnant or more with a uterus above the umbilicus should have the uterus left laterally displaced during compressions to avoid aortocaval compression. A 15 degree tilt of the long board or lateral displacement. What is the Maternal Fetal Triage Index? - Answer- A valid reliable 5 level triage tool that may assist in the triage of obstetric trauma patients. Displacing the uterus off the vena cava can improve CO by - Answer- approximately 30%! Continuous fetal monitoring is recommended... - Answer- for all pregnant patients 20 or more weeks gestation... or (uterus above belly button). Fundal height measurement - Answer- equals the approximate gestational age in weeks, until week 32. Belly button is 20 weeks Height of last rib is 26 weeks costal margin is 36 weeks Any fundal height indicating 23 or more weeks... - Answer- at the last rib and above is consistent with a viable fetus. What type of blood should a pregnant trauma patient receive? - Answer- O-NEG baybay. Initiate cardiotocography in any mother - Answer- 20 or more weeks gestation, must be monitored for at least 6 hours. What is the serum lab test that detects fetal red cells in the maternal circulation? - Answer- Kleinhauer Bette KB serum test. This lab is used to determine if hemorrhage of fetal blood through the placenta and into maternal circulation. KB test is an important detector of abruptio placentae, preterm labor and need to administer Rh negative globulin when mom is Rh negative and fetus is Rh positive. Continue fetal monitoring for a minimum of ---- hours for any viable pregnancy and up to _____ hours if there is abdominal trauma - Answer- 6..... 24 Sonography has __________ for diagnosis placental abruption, - Answer- POOR.... they miss 50-80% of abruptions. In addition to routine labs a - Answer- Prothrombin (PT ) and PTT and serial coags should be drawn. Beta Human Chorionic gonadotropin (BHCG) Measure and record fundal height every - Answer- 30 minutes. Pediatric Mechanisms of injury and biomechanics - Answer- Blunt trauma MVC suffocations drownings fires/burns. No. 1 cause of fatalities is TBI. Primary Survey/ Resuscitation - Answer- Survival rates in pediatric emergency can be directly correlated with 1.RAPID AIRWAY MANAGEMENT, 2.INITIATION OF VENTILATORY SUPPORT, AND 3.EARLY RECOGNITION OF AND EARLY RESPONSE TO INTRA abdominal AND intracranial hemorrhages A STEMI is a __________ resulting from a _________. - Answer- Complete Occlusion of a coronary artery caused by a ruptured Plaque leading to blood clot formation in the coronary. STEMI diagnosis - Answer- Chest pain + positive cardiac enzyme (TROP. 0.4), and --ST segment ELEVATIONS greater than 1 mm in two or more contagious leads V1-V6 -Reciprocal (depressions) changes in leads II, III, AVF STEMI EKG findings - Answer- STEMI STEMI EKG findings more - Answer- -St elevations 1mm in Limb leads: 1, II, III, avF, avL -St elevations 2mm in precordial leads (v1-v6) AND/OR -NEW LBBB Contiguous leads with reciprocal changes in opposite leads First degree Heart Block EKG - Answer- AV block Prolonged PR Interval greater than 120-200 ms second degree heart block type 1 Wenkebach - Answer- AV block in which occasional electrical impulses from the SA node fail to be conducted to the ventricles. PR interval progressively lengthens greater than 120-200ms + dropped beats. Maternal cardiopulmonary arrest...If any moribund patient is 24 weeks or more perimortem c section must be considered. AHA recommends c section initiation within... - Answer- 4 minutes... delivery with in 5 minutes of any unsuccessful maternal resuscitative attempts. Second Degree Heart Block (Mobitz II) - Answer- = Damage AT av node - moderate • PR-interval is normal; QRS complexes are dropped erratically • ALL must have a pacemaker in the next 72 hrs. STEMI Nitro gtt - Answer- 5-10 mcg per minute Titrate by 10 mcg max dose 300 mcg per minute How do you mix epi? - Answer- Mix 1 mg in 1 L NS or D5W or LR for a concentration of 1 mcg/ ml What's the epi dose for hypotension s/p arrest? - Answer- 0.1 - 0.5 mcg/kg/min What is the epi dose for anaphylaxis? - Answer- Pediatric Epinephrine dose - Answer- PALS 2020 update - Answer- AHA 2020 BASIC BP Diastolic BP of at least 25mmhg in infants and at least 35 mmhm in children correlates with better outcomes. PALS Brady with a pulse - Answer- Assess airway, breathing, mental status Most common cause is hypoxia! could also be hypothermia and or medications. s/s of shock? AMS? hypotensive? Start CPR if any of these Always start CPR if HR 60 bpm iv access Give Epi 0.01 mg/kg (0.1ml of 0.1mg/ml solution) Repeat Q 3-5 minutes Initial management of pediatric respiratory distress or Failure A - Answer- 1. A-ABC. Support open airway: Comfort or Head tilt chin lift. Jaw thrust. Clear airway if indicated. (suction nose or mouth if indicated) Consider OPA or NPA. IDENTIFY type and Severity of respiratory problems Initial management of pediatric respiratory distress or Failure B - Answer- 2. B-Monitor Spo2 withPulse ox. Provide high concentration O2, via non rebreather -Administer inhaled meds: Albuterol or Epi. as needed -Assist ventilation with child ambu + o2 if needed. Prepare for intubation if needed. Initial management of pediatric respiratory distress or Failure C - Answer- 3.C-Monitor heart rate, rhythm and BP. Establish IV/IO access. and fluids/ meds as needed. Evaluate Identify Intervene What is an upper airway obstruction? - Answer- Interruption in airflow through nose, mouth, pharynx, or larynx. The large always outside the thorax. PALS What causes upper airway obstruction? - Answer- Airway Swelling (anaphylactoid rx) ,Infection r/t croup Aspirated foreign body enlarged tonsils or adenoids Decreased level of consciousness GCS of 8? Infants and small children are especially vulnerable to - Answer- Upper airway obstruction. Infants are obligate nose breathers. PALS Management of upper airway obstruction - Answer- position of comfort, or jaw thrust chin lift 100% FIO2 via non rebreather -Carefully weigh decision to suction. Don't do it if it's croup of anaphylaxis. -give nebulizer epinephrine particularly if swelling is beyond the tongue. -Give inhaled or IV cortical steroids -OPA for AMS and NPA for ams with a gag. - consider cpap. -Only experienced intubation should be considered ensure pt can be ventilated prior to paralytic - prepare for difficult airway (needle cricothyroidotomy) In infants and children, retraction of the skin, muscles, and other tissues around the clavicle and between the ribs indicates: A. shallow breathing. B. labored breathing. C. see-saw breathing. D. normal breathing. - Answer- PALS Management of upper airway obstruction caused by croup. - Answer- PALS Management of Anaphylaxis - Answer- In addition to ABC.... - Administer IM epic by auto injector or regular syringe every 10 to 15 minutes as needed. Repeat doses may be needed. -Treat bronchospasm with albuterol MDI or Nebulizer -Give continuous nebulizer treatment if needed. -**For severe respiratory distress anticipate further airway swelling and prepare for endotracheal intubation PALS Management of anaphylaxis continues - Answer- To treat hypotension: -Place child in trendelenburg position as tollerated -administer isotonic crystalloid (NS/LR) at 20ml/kg repeat as needed. -For hypotension unresponsive to fluids and IM epinephrine, start a gtt at 0.05-2 mcg/kg/min titrate to effect Pals Management of anaphylaxis continues finally... - Answer- Administer Diphenhydramine 1mg/kg and an H2 blocker, ranitadine IV. -Administer methylprednisolone or equivalent IV PALS Management of Lower Airway Obstruction - Answer- After ABC... If assisted ventilation is needed provide at a slow rate. PALS Management of Lower Airway Obstruction Bronchiolitis - Answer- After ABC -Suction as needed Consider labs: viral studies, chest X-ray and ABG trial nebulize epi or albuterol, if no improvement, Discontinue PALS Management of acute asthma Mild to Moderate - Answer- -Administer humidified O2 in high concentration via nasal cannnula or O2 mask. K -Keep SpO2 = 94% -Administer Albuterol via MDI or Nebulizer -PO corticosteroids PALS Management of Moderate to Severe Asthma - Answer- -Administer O2 for a SpO2 = 94% NC or NRB -Albuterol via MDI with Spacer or Nebulizer -Continuous Albuterol may be needed