Critical Care Paramedic (Kyle Faudree's Flight Paramedic Certification) Study Guide Qs & A, Exams of Career Counseling

Download Critical Care Paramedic (Kyle Faudree's Flight Paramedic Certification) Study Guide Qs & A and more Exams Career Counseling in PDF only on Docsity! Critical Care Paramedic (Kyle Faudree's Flight Paramedic Certification) Study Guide Qs & As. Hyperthyroidism/Grave's Disease/Thyrotoxicosis/"Thyroid Storm" (pg.111) - Patient presents with weight loss, palpitations, nervousness, heat intolerance Exophthalmos (AKA proposes) 'bulging of the eye' AVOID Aspirin (ASA) - Prevents binding of thyroglobulin, making the situation worse Treatment: IV Fluids 1st, Beta Blockers (Propranolol), Steroids (Dexamethasone), and Tylenol for fever. Septic Shock (pg.113) - Someone who is in shock second degree to sepsis (infection in the bloodstream) Hypotensive with normal HR Hypotensive while being refractory to fluids Patient needs IV fluid therapy and vasopressors Lavished (Norepinephrine) is vasopressor of choice in profound hypotension Do not use Etomidate in RSI (due to its adrenal suppression) *Also do not use Etomidate in Addison's disease also due to the adrenal suppression Pancreatitis (pg.113) - Pain that is usually centered in the upper middle or upper left abdomen. Often radiates from the front of the abdomen through to the back, begins or worsens after eating, lasts a few days, and may feel worse when a person lies flat on their back. The digestive enzymes in the pancreas are destroying the pancreas. Increased lipase levels (usually >3x normal) *Amylase may also be increased but Faure did not preface this in his study guide notes. Demerol for pain (b/c Morphine has the ability to cause spasms of the Sphincter of Odd) Typically requires surgical intervention. Grey Turner's Sign (pg.113) - Flank ecchymosis caused by hemorrhagic pancreatitis. Cullen's Sign (pg. 113) - Per umbilical ecchymosis caused by hemorrhagic pancreatitis. Hypothyroidism/Myxedema Coma (pg. 112) - Patient presents with fatigue, cold intolerance, weight gain, puffy eyelids, sparse hair, possibly goiter. Primarily occurs in women. >90% cases in winter (b/c the patient has cold intolerance and is not suffering from hypothermia) Officially Myxedema Coma upon changes in LOC. Treatment: Levothyroxine (Synthroid) (T4) or Trio stat (T3) IV Cushing's syndrome (pg.112) - Buffalo hump, moon face, thin arms and legs, purple striate on abdomen. Causes: Excessive use of corticosteroids (Iatrogenic, from corticosteroid treatment(s)) or Tumor Treatment: Usually resolves when corticosteroids are stopped or tumor is removed. Adrenal Insufficiency/Adrenal Crisis (pg. 112) - Also known as (AKA): Addison's disease Patient presents with depression, malaise, salt craving, and bronze colored skin like JFK. Treatment: Oral steroids (Prednisone) Negative Adrenocorticotropic hormone (ACTH) testing, also known as corticotrophin or cosyntropin test. No Etomidate in RSI due to adrenal suppression. Laboratory Values Basic Metabolic Panel (BMP or CHEM7) (pg.106) - Sodium (Na+) Primary Extracellular Action: 135-145 me/L [Helps nerves and muscles interact] Potassium (K+) Primary Intracellular Action: 3.5-5.0 me/L MOST DANGEROUS ABNORMALITY [Responsible for cell excitability, resting membrane potential] Chloride (Cal-) Extracellular Anion 95-105 me/L [Maintains osmotic pressure, and helps the stomach produce Hall or Hydrochloric Acid] Carbon Dioxide (CO2 gas) 22-26 me/L [Acid Base Balance contributor] BUN Blood Urea Nitrogen 6-24 mg/LD. Meningitis (pg.99) - Caused by inflammation of the meninges Disease is carried in the Cerebral Spinal Fluid (CSF) Treatment based on cause (bacterial, viral, fungal) Triad of Nuchal Rigidity (Neck Stiffness), Photophobia (Intolerance of bright light), and Headache. PPE: Gloves, Mask, and Gown. Brudzinki's Sign: (pg.99) - The appearance of involuntary lifting of the legs when lifting the patient's head with the patient lying supine. Kerning’s Sign: (pg.99) - Severe stiffness of the hamstrings causes an inability to straighten the leg when the hip is flexed to 90 degrees. "Kicking Kerning’s" Neurological Emergencies (p.92) - MAP (Mean Arterial Pressure) = SBP + (2 x DPB)/3 Normal Range: 80-100 mmHg. Ideal MAP 90 mg. CPP (Cerebral Perfusion Pressure) = MAP - ICP Normal Range: 60-80 mmHg. Keep CPP above 60 mg. ICP Normal Range: 0-10 mmHg. ICP >20 mmHg has high mortality. (Monroe-Kellie Doctrine) ICP Transducer is placed at the foramen of Monroe (level of ear). Signs/Six of Herniation (pg.92) - Change in LOC Pupil Reaction Decorticate (Abnormal Flexion) Brainstem DE cerebrate Posturing (Abnormal Extension) Cushing's Triad (pg.92) - Results from increased intracranial pressure leading to brainstem herniation Irregular or Decreased Respirations, Bradycardia, Hypertension w/ Increased Pulse Pressure. Treatment of Brainstem Herniation (pg.93) - Paralyze (RSI) Intubate (RSI) Hyperventilate (Goal PaCO2 30-35 mmHg) Manito (Decrease fluid in the cranial vault, 1g/kg bolus over 5 minutes) Hypertonic Saline (Give slowly to prevent Central Pontine Myelinolysis) Barbiturate Coma (Lowers O2 Demand) Hypoxia and Hypercapnia cause cerebral blood vessels to dilate, increasing blood flow and volume, furthering increasing ICP Treatment of Seizures caused by Herniation: Benzodiazepine, and then Phenytoin (Dilantin) or Fosphenytoin (Carvery). Phenytoin (Dilantin): 1 Gram loading dose at 50 mg/minute Lasix (Furosemide) can be used in the setting of herniation after Manito (but not as affective). Central Pontine Myelinolysis is caused by reversing hypernatremia too quickly. RAISIN BRAIN SHRINKAGE What should you NOT use for treatment of Brain Herniation? (pg.93) - Do NOT use Hypotonic Solutions or Glucose! Hypernatremia is associated with cerebral edema Hyperglycemia makes brain injuries worse, most likely with cerebral edema (Swelling) Respiratory Changes in Cerebral Herniation (pg.92) - Chine-Stokes: Breathing becoming shallower until it stops for a while (apnea), and then breathing starts again, rapidly crescendos to a peak before decreasing again. Pediatric Age Range (pg.88) - Neonate: Birth to 28 days Infant: 28 days to 1 y/o Toddler: 1y/o to 2y/o Child: >2 y/o Pediatric Emergency Intervention Formulas (pg.88) - ETT Diameter: (16 + AGE)/4 If required ETT size > or = 5.5 mm CUFFED ETT should be used. If <5.5 use an Unstuffed ETT. SUCTION INSERTION CHEST TUBE (2/3/4) 2 x ETT Size = Suction/NG Foley Diameter (EX: 5.0 ETT = 10fr Suction/Foley) 3 x ETT Size = ETT Insertion Depth (EX: 7.0 ETT = 21cm ETT Insertion Depth) 4 x ETT Size = Chest Tube (EX: 5.0 ETT Size = 20fr Chest Tube) Normal Systolic BP = 90 + (2 x AGE) Hypotensive Systolic BP = 70 + (2 x AGE) Defibrillation 2J/kg Pediatric Fluid Emergency Resuscitation (pg.88) - Neonate/Infant: 10cc/kg (< 1 y/o) Toddler/Child: 20 cc/kg (> 1 y/o) (No more than 2 fluid bolus infusions) Average Circulating Blood Volume: 80-90 mL/kg Pediatric Maintenance Fluids "4/2/1" (pg.89) (Non-Emergency) - 1-10 kg -> 4cc/kg/hr. 10-20 kg -> 2cc/kg/hr. >20 kg -> 1cc/or/hr. Example: 25kg child needs fluids. 1st 10kg = 40 cc 2nd 10kg = 20 cc Last 5kg = 5cc Answer: Total Fluid Required 65 cc/hr. 1 cc = 1 mL Pediatric Glucose Management (pg.89) - D stick or BGL < 60 mg/ld. Neonate 2cc/kg D10 Infant/Toddler 2 cc/kg D25 Child 2 cc/kg D50 Pediatric Airway Problems (pg. 89) - Stridor (Upper Airway Inhalation Problem) Wheezing (Lower Airway Inhalation Problem) Bronchiolitis (pg.89) - Swelling of the bronchiole walls >90% Viral Most Common Viral Causes: Respiratory Syncytial Virus (RSV) Highly Contagious S/S: Cough, Dyspnea, Nasal Flaring, Wheezing/Crackles upon Lung Sounds Assessment Treatment: Supportive care, O2, Fluids, Contact Isolation. Croup (pg.90) - Swelling of the vocal cords Most likely viral causation/infection Gradual onset with Upper Respiratory Infection (URI), no drooling upon assessment "Seal Like" Barking Cough Steeple Sign on A/P Neck X-Ray If a mother is Rh= (negative), ALWAYS administer Roam. Roam supplied by the blood bank or transfusion services department in hospital. Mother has Rh antibodies to Rh+ antigens. The majority of the population of Rh+. Administration of Roam occurs: At 28 weeks gestation, after delivery, after any trauma/bleeding/potential bleeding where firstborn baby's blood cells are transferred to the mother's circulatory system. Miscellaneous Obstetrics Pearls (pg.82) - Do not pull on the umbilical cord after delivery of the baby, this can cause uterine inversion. Uterine inversion requires manual replacement. Gestational diabetic mothers are more likely to give birth to children with hypoglycemia and also large-sized neonates (fetal microsomal). This is b/c the baby's pancreas produces insulin at normal levels, and once no longer inside the mother, the glucose levels drop dramatically. HYPOGLYCEMIA IS A COMMON CAUSE OF SEIZURES IN THE NEWBORN. Miscellaneous Obstetrics Pearls (pg.82) (Condition vs. Treatment) - Condition vs. Treatment HTN = Labetalol, Hydralazine, Methyldopa Post-Partum Hemorrhage = Fundal Massage, Pitocin, and Methergine. Eclampsia (Seizures) = Valium (Diazepam) Uterine Contractions = Terbutaline, MgSO4 Pre-Eclampsia/Eclampsia = MgSO4 MgSO4 (Magnesium Sulfate) Neonatal Emergencies (pg.83) - Birth to 28 days old Infant heads are larger in proportion to the rest of the body. This results in a natural sniffing position. Neonates/Infants are obligate nasal breathers. Suction the mouth 1st, then the nose. May utilize bulb syringe, Delete Suction, or 10fr or 14 for suction catheters. Airways secretion and edema causes serious problems earlier than in adults. Consider nasogastric tubes in all intubated neonates. Meconium (pg.83) - Meconium is sterile (consists of hair, teeth, skin cells, & etc.). Deep suction (below vocal cords) is ONLY indicated if the neonate is not vigorous if meconium is present at birth. Surfactant is inactivated by meconium. IsoletteTM Incubator (pg.83) - Device to put any preterm or term infant to maintain heat, provide supplemental oxygen, and to protect from the environment. Patient must be secured inside the incubator during flight. Preterm neonate <5kg Distress in a neonate Infants/Pediatrics lose heat quicker than adults due to their BSA to Mass Index Ratio. Neonatal Infection Disease (p.83) - Top 3 Killers in the 1st 24hrs 1) Sepsis (Group B Streptococcus Infection TX: AMP-GENT) 2) Respiratory Complications 3) Cardiac Problems Tetralogy of Fallout (pg.87) - Right to Left Shunt Consists of Pulmonary Stenosis, Aortic Coarctation, Transposition of Great Vessels - the Aorta and Pulmonary arteries are switched, and Ventricular Septal Defect (VSD). "That Spells" sudden cyanosis and syncope TX: Knees to chest, Morphine Further TX. Perform RSI, Intubate, and 100% O2. Miscellaneous Neonatal Information (pg. 87) - An umbilical cord has 2 Arteries 1 Vein If the newborn only has 1 Artery and 1 Vein in the cord (single artery cord), the Renal System is likely to be affected.