Critical Care/Flight Paramedic Exam Verified Questions and Answers 2023, Exams of Nursing

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Critical Care/Flight Paramedic Exam Verified Questions And

Answers 2023

Babinski reflex ✔✔extension and spreading of toes when bottom of foot is stroked. sign of nervous system lesion Battles sign ✔✔bruise behind ear, basilar skull fracture becks triad ✔✔jvd, muffled heart tones, hypotension. from cardiac tamponade brudzinski sign ✔✔flexion of the neck results in flexion of the hip. meningitis cooper nails sign ✔✔ecchymosis on perineum, labia, scrotum. sign of pelvis fracture Cullen’s sign ✔✔bruising around umbilicus. Sign of pancreatitis or ectopic pregnancy grey turners sign ✔✔discoloration of skin around flank. sign of pancreatitis Hamman’s sign ✔✔crunching sound of heart with asynchronous heart beat. sign of mediastinal emphysema/tracheobronchial disruption kheers sign ✔✔left shoulder pain associated with splenic rupture keyrings sign ✔✔pain to knee extension when hip is at 90 degrees. sign of meningitis levines sign ✔✔pain with clutched fist over midline of chest. sign of cardiac chest pain mcburneys sign ✔✔tenderness 2/3 the distance between umbilicus and ileum. sign of appendicitis muphys sign ✔✔pt unable to take deep breath on inspiration with deep palpation beneath right coastal margins. sign of gall bladder issues S2 "dub" heart tones ✔✔aortic and pulmonary valve closure s1 "lub" sound ✔✔bicuspic/tricuspid valve closure stroke volume is affected by ✔✔preload, afterload, contractility s4 heart tone ✔✔indicative of stiff or noncompliant ventricle, like with an old MI s3 heart tone ✔✔ventricle stretch due to fluid overload

right coronary artery is typically repaired by using ✔✔saphenous vein dresslers sign ✔✔pericarditis from recent MI or cardiac surgery alpha 1 stimulation results in ✔✔increased SVR/vasoconstriction beta 1 stimulation results in ✔✔increased HR, contractility janeway lesions and osler nodes are indicative of ✔✔endocarditis elevated BNP signals ✔✔increased stretching of ventricles. found in CHF where should a cardiac transducer be placed? ✔✔phlebostatic axis (4th intercostal space midaxillary) what does the dicrotic notch symbolize? ✔✔aortic valve closing saline from ART line should infuse at what rate ✔✔3ml/hr normal central venous pressure (CVP) ✔✔ 2 - 6 when utilizing a swan ganz catheter, never exceed ____mL of air in distal balloon ✔✔1. coronary perfusion pressure calculation ✔✔PAWP-DBP (should be 50-60) PAWP range ✔✔ 8 - 12 PVR range ✔✔ 50 - 250 PA pressure ✔✔ 15 - 25 systolic, 8-15 diastolic SVR range ✔✔ 800 - 1200 what does PVR signify ✔✔right heart afterload, pulmonary vascular resistance what is PCWP ✔✔same as pAWP left heart preload is also called ✔✔left ventricular end diastolic pressure LVEDP what is CI ✔✔same as CO

what happens to pressures during cardiogenic shock ✔✔decreased cardiac output (CO/CI), increased everything else what happens to pressures during hypovolemic shock ✔✔decreased SVR, increased everything else what happens to pressures during anaphylactic shock ✔✔increased CO/CI, decreased everything else when should PAWP readings be taken ✔✔at the end of exhalation if a swan ganz catheter is in the right place, the two pressures that can be continuously monitored are ✔✔CVP and PA (central venous and pulmonary artery) what should you do if the IABP console shuts down during transport? ✔✔inflate balloon with air every 3- 5 minutes. this prevents formation of clots most deadly IABP timing error ✔✔late deflation what does late deflation look like? ✔✔diastolic notch higher than unassisted, waveform has widened appearance signs that IABP balloon has migrated? ✔✔decreased urinary output and decreased pulse to left hand what does early inflation of IABP look like? ✔✔weak/loss of dicrotic notch what does early deflation of IABP waveform look like ✔✔"cliff" shape what does late inflation of IABP waveform look like ✔✔a W shape, widened do you have to manually purge the IABP at altitude? ✔✔no for a patient in A-fib what is the best trigger for the IABP? ✔✔pressure mode normal value of ICP ✔✔ 5 - 15 ICP above what mmHg has high mortality? ✔✔above 20 normal cerebral perfusion pressure (CPP) ✔✔ 70 - 90 ICP monitoring waveform looks like ✔✔3 humps, each lower than the last

P1 on ICP waveform ✔✔systole P2 of ICP waveform ✔✔compliance of brain (percussion wave) P3 of ICP waveform ✔✔dicrotic notch what does P2 elevation on ICP waveform signify? ✔✔poor compliance, increasing ICP hyperglycemia in brain injuries ✔✔makes it worse hyponatremia in brain injuries ✔✔associated with brain edema subdural hematoma CT presentation ✔✔looks like a crescent moon epidural hematoma CT presentation ✔✔lens shape central cord syndrome ✔✔upper extremity weakness that is greater than lower extremeties anterior cord syndrome ✔✔ most common cause of encephalitis ✔✔Herpes simplex 1 status epilepticus is characterized by ✔✔one seizure lasting longer than 5 minutes or recurrent seizures longer than 30 minuets scorpion treatment ✔✔atropine and diazepam if you dont have anascorp crofab, what is it and dose ✔✔snake antivenom. give 4-6 vials initially and maintenance 2 vials q6 (3 rounds) for 18 hours following treatment for acetaminophin OD ✔✔mucamyst (N-acetylcystine) treatment of ethylene glycol toxicity ✔✔fomepizole (antizol) what happens with phenergan when you administer and they have an upward gaze ✔✔this is a dystonic reaction. give benadryl SLUDGE, what is it and what treatment ✔✔cholinergic toxicity. treat with pralidoxime and atropine 12 lead signs of hyperK ✔✔either flat P wave or peaked T wave

trosseaus sign ✔✔ chvosteks sign ✔✔ what is the only shock with a high cardiac index? (CI/CO) ✔✔septic what does it mean to have an INCREASED anion gap? ✔✔metabolic acidosis what is most likely injured in a diving accident? ✔✔C5 and C Newton's second law ✔✔Mass(force)=acceleration Newton's first law ✔✔an item in motion will remain in motion unless acted on by an outside force Newton's third law ✔✔for every action there is an equal and opposite reaction what is the most important predictor in GSW damage? ✔✔velocity kehrs sign is a sign of a ✔✔splenic rupture chance fracture ✔✔T12-L1. caused by rear impact C2 fracture ✔✔hangmans fracture C1 fracture ✔✔jeffersons fracture collee fracture ✔✔bilateral distal radial fractures from catching yourself while falling most commonly injured hollow organ in abdominal trauma ✔✔small intestine what is the most dangerous pelvic fracture ✔✔vertical shear Le Forte I ✔✔horizontal across maxilla Le Forte II ✔✔bridge of nose and around mouth, usually from downward blow to nose Lefort III ✔✔craniofacial dissociation for femoral vein cannulation, is artery or vein more lateral? ✔✔artery is more lateral, vein is medial do pRBC and FFP require ABO compatibility ✔✔yes

leading cause of death in transfusion reactions ✔✔TRALI - transfusion related acute lung injury ABO incompatibility can cause what reaction ✔✔hemolytic blood urea nitrogen ✔✔ 8 - 23 mEq/L creatinine levels ✔✔0.7 to 1. normal WBC count ✔✔ 4500 - 11000 platelet count ✔✔150k - 400k prothrombin time ✔✔ 10 - 13 second partial thromboplastin time ✔✔ 21 - 35 sec INR levels ✔✔0.9 - 1. calcium levels ✔✔8.8-10. anion gap ✔✔12 +- 4 RBC count ✔✔5 million/mL osmolality # ✔✔ 275 - 295 what is proper ET placement? ✔✔ 2 - 3 cm above carina, level of T2-T4, 1 inch above carina what is anectine ✔✔succinylcholine target for ET cuff pressure ✔✔ 20 - 30 what is LOAD ✔✔pneumonic for pre RSI meds. Lidocaine, opiates, atropine, defasciculation dose 7Ps of RSI ✔✔preparation, preoxygenate, pretreatment, paralysis, protect and position, placement, post intubation pneumonic for pressure alarms ✔✔DOPE

normal tidal volume ✔✔ 4 - 8 ml/Kg normal minute ventilation volume ✔✔ 4 - 8 lpm VE symbolizes ✔✔ventilation volume what is important to monitor when using pressure control mode on a ventilator? ✔✔VTE (expired tidal volumes) severe hypothermia and what happens ✔✔32C, 89.6F. shivering stops hypothermia is defined as ✔✔core temp below 95 primary cation lost in heat injuries ✔✔sodium what ODs can cause diabetes insipidus? ✔✔keppra, pheytoin (dilantin) diabetes insipidus treatment ✔✔DDAVP iron overdose treatment ✔✔deferoxamine what is a patient seeing "yellow and green halos" a sign of? ✔✔digoxin toxicity mydriasis ✔✔dilated pupils beta blockers in cocaine ovrdose ✔✔CCP doesnt want you to give it, can cause unopposed alpha adrenergic activity some anticholinergic drugs ✔✔atropine, dramamine, benadryl, anything that ends in - ine anticholinergic antidote ✔✔physostigmine mothers plasma increases by ___% during pregnancy ✔✔40% late decelerations cause ✔✔uteroplacental insuffiency/pre eclampsia variable decelerations cause ✔✔cord compression - nuchal cord or prolapsed cord tocolytic ✔✔drugs that stop labor what drugs are tocolytics ✔✔mag and terbutaline

normal fetal heart rate variability ✔✔ 15 - 20 antidote for mag toxicity ✔✔calcium HELLP syndrome ✔✔in pregnancy. Hemolysis, Elevated Liver enzymes, Low Platelets. has jaundice and RUQ pain treatment for HELLP ✔✔steroids to stimulate fetal lung maturity how to suction neonate ✔✔mouth before nose most common cause of neonatal sepsis ✔✔group B strep abnormality in newborns where bone blocks the nasal passage ✔✔choanal atresia hyaline membrane disease ✔✔neonatal ARDS. causes surfactant deficiency omphalocele ✔✔protrusion of viscera what has worse outcome, omphalocele or gastrocschisis? and why? ✔✔omphalocele, these pts typically have underdeveloped lungs as well treatment for neonatal hypoglycemia ✔✔2ml/kg of D what do hematomegaly and cardiomegaly in a neonate signify, and what is the treatment? ✔✔signify CHF, treatment digoxin/digitalis ventricular septal wall defect is an example of ✔✔right to left shunt if a neonate deteriorates after oxygen administration what does this mean ✔✔they need the patent ductus arteriosus to live (PDA. it is closed by oxygen) what drug keeps the PDA open ✔✔prostaglandin E what forms after closure of the PDA? ✔✔ligamentum arteriosum if a child squats down to improve SVR this is a sign of ✔✔tetralogy of fallot ET tube diameter in peds ✔✔(age + 16)/ what age can you preform a surgical cric on ✔✔>8 yo hypotension for peds pts formula ✔✔70+ (pt age x2)

peds maintenance infusion formula ✔✔4ml(kg) for first 10kg, then 2ml/kg for 10-20, then 1ml/kg for each kg over 20 kids show signs of hypotension at loss of ______% blood volume ✔✔25% ballance sign ✔✔dullness to LUQ associated with splenic rupture treatment for syndrome of inappropriate antidiuretic hormone ✔✔hypertonic saline what to treat pt with liver disease with ✔✔lactulose, decreases ammonia in blood of liver failure pts what causes saponification burns ✔✔alkali asterixis ✔✔flapping of hands, associated with liver failure barodontalgia happens when ✔✔on ascent barotitis media happens when ✔✔on descent treatment for hypothyroid ✔✔synthroid chovsteks sign ✔✔hyper reactive face muscles. sign of calcium deficiency tell me about BNP and levels ✔✔B type Natriuretic Peptide is a measure of heart failure. less than 100, no failure. greater than 300, mild. greater than 600 moderate, greater than 900 severe what is uremic pericarditis ✔✔post dialysis pericarditis a base deficit >-4 indicates ✔✔need for blood transfusion SaO2 90, 80, 70 corresponds to to PaO2 of ✔✔60,50, what pH and temp shift oxyhemoglobin curve to the left ✔✔decreased temp, decreased pH what pH and temp shift oxyhemoglobin curve to the right ✔✔increased temp, increased pH what does partially compensated mean ✔✔ph, Co2 and HCO3 are all outside of normal range

CO2 change 10, what does this do to pH and K+? ✔✔pH goes 0.8 in opposite direction, K+ goes 0.5 in same direction pH increases 0.15, what does this do to HCO3? ✔✔changes 10 in same direction critical values for intubation ✔✔pH less than 7.2, CO2 greater than 55, PaO2 less than 60 number one cause of metabolic acidosis ✔✔lactic acidosis peds ET tube size ✔✔(16+age)/ age for needle cric ✔✔8yo and below what is LEMON for ✔✔difficult airway. look, evaluate, mallampati, obstructions, neck mobility what is HEAVEN for ✔✔difficult airway predictor. hypoxemia, extremes of size, anatomic, vomit, exsanguination, neck mobility issues ET tube cuff pressure ✔✔ 20 - 30 colormetric saying ✔✔yellow is yes, purple is pull lidocaine for RSI ✔✔use in head injury patients, blunts the cough reflex to prevent increase in ICP atropine for RSI ✔✔use for pts less than 1 yo to prevent reflex bradycardia defasciculation dose for RSI ✔✔1/10 dose of paralytic contraindication for etomidate ✔✔renal suppression, shock, copd, asthma difference in RSI in hemodynamically unstable/shocky pts ✔✔half the sedation dose and double the paralytic dose. also ketamine is good for shock how to cut for cric ✔✔vertical incision first dead space formula ✔✔2ml/kg biots respirations ✔✔rapid shallow breaths followed by periods of apnea ataxic respirations ✔✔all over the place. very poor prognosis

gold standard for oxygenation and gold standard for ventilation ✔✔oxygenation - pulse ox. ventilation - capno minute volume number ✔✔ 4 - 8 L/min what needs to be monitored with a ventilator using pressure control? ✔✔volumes what needs to be monitored with a ventilator using volume control? ✔✔pressures PIP and PPLAT numbers ✔✔pip less than 35, pplat less than 30 asthma I:E ratio ✔✔increase to 1: ARDS PAWP ✔✔high, like 18- 20 ARDS vent settings ✔✔increased PEEP, increased frequency, low tidal volumes major extracellular anion ✔✔Cl- trosseaus sign ✔✔sign of hypocalcemia, twtiching with bp cuff bicarb replacement formula ✔✔0.1(kg)(-BE) heparin overdose treatment ✔✔protamine sulfate normal INR and therapeutic INR ✔✔1 second normal, 2-3 seconds therapeutic (like with warfarin/coumadin) when to increase urine output to 100ml/hr ✔✔electrical burns, rhabdo, hemolysis who is more fluid deficient, HNNK or DKA? ✔✔HNNK. can be 8-10 liters deficient DI treatment ✔✔vasopressin/DDAVP. fluid admin. usually they are very fluid deficient what to avoid in thyroid storm/graves disease ✔✔aspirin - will make it worse treatment for thyroid storm ✔✔fluids first then beta blockers, steroids, tylenol lactate in septic shock ✔✔greater than 4 ambient operating temps of ambulance ✔✔between 68 and 78 degrees

performance temps of ambulance ✔✔-30 to 122 degrees sirens must be audible from a distance of ✔✔500 feet PVR - what is it and range ✔✔pulmonary vascular resistance. it is right heart afterload, 50 - 250 normal troponin ✔✔<. code 1200 ✔✔VFR code 7500 ✔✔hijacking code 7600 ✔✔communications failure code 7700 ✔✔emergency requirements for permanent LZ ✔✔perimeter heading, 2 approach and departure headings, windsock, D fire extinguisher land immediately - ✔✔engine failure, fire in cockpit land as soon as possible ✔✔chip light, low oil pressure, low transmission oil land as soon as practical ✔✔to look at something non emergent post crash sequence ✔✔too freaking bad. throttle, fuel, battery ELT frequency is on ✔✔121. who is responsible for search and rescue of a downed aircraft ✔✔civil air patrol atmospheric pressure at sea level ✔✔760 torr physiologically deificient zone ✔✔10k-50k MSL at what altitude does night vision begin to be affected? ✔✔5k MSL what are signs of cabin pressure loss ✔✔windows fogging, temp cooler boyles law ✔✔pressure of a gas decreases as volume of container increases

charles law ✔✔at a constant pressure, volume of gas is directly proportional to temp of gas temperature changes in altitude ✔✔every 1000ft MSL increase will cause a temerature drop of 2 degrees celsius aircraft performance is worse in what weather ✔✔warm what is the formula for adjusting FiO2 for ascent? ✔✔P1(FiO2)/P2 = FiO2for ascent barodontalgia occurs when ✔✔ascent types of DCS (decompression sickness) ✔✔type I - joint or skin pain. type 2 - AMS normal creatinine levels ✔✔0.7 - 1. heparin OD antidote ✔✔protamine sulfate warfarin over dose treatment ✔✔vitamin K