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Critical Care Paramedic Study Guide: Hyperthyroidism, Septic Shock, Pancreatitis, and More, Exams of Nursing

This study guide provides a comprehensive overview of critical care paramedic topics, including hyperthyroidism, septic shock, pancreatitis, and burn management. It includes detailed explanations of symptoms, treatment protocols, and key concepts related to these conditions. The guide also covers important neurological emergencies, such as spinal shock, neurogenic shock, and meningitis, providing insights into their causes, symptoms, and management strategies. Additionally, it delves into the principles of fluid resuscitation, burn formulas, and newton's laws of motion, offering valuable knowledge for paramedics in critical care situations.

Typology: Exams

2024/2025

Available from 01/05/2025

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Download Critical Care Paramedic Study Guide: Hyperthyroidism, Septic Shock, Pancreatitis, and More and more Exams Nursing in PDF only on Docsity!

Critical Care Paramedic (Kyle

Faudree's Flight Paramedic

Certification) Study Guide questions

with answers

Hyperthyroidism/Grave's Disease/Thyrotoxicosis/"Thyroid Storm" (pg.111) - ....🔰VERIFIED ANSWERS.... ✔✔Patient presents with weight loss, palpitations, nervousness, heat intolerance Exophthalmos (AKA proptosis) 'bulging of the eye' AVOID Aspirin (ASA) - Prevents binding of thyroglobulin, making the situation worse Treatment: IV Fluids 1st, Beta Blockers (Propanolol), Steroids (Dexamethasone), and Tylenol for fever. Septic Shock (pg.113) - ....🔰VERIFIED ANSWERS.... ✔✔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 Levophed (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) - ....🔰VERIFIED ANSWERS.... ✔✔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 Faudree 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 Oddi) Typically requires surgical intervention.

Grey Turner's Sign (pg.113) - ....🔰VERIFIED ANSWERS.... ✔✔Flank ecchymosis caused by hemorrhagic pancreatitis. Cullen's Sign (pg. 113) - ....🔰VERIFIED ANSWERS.... ✔✔Periumbilical ecchymosis caused by hemorrhagic pancreatitis. Hypothyroidism/Myxedema Coma (pg. 112) - ....🔰VERIFIED ANSWERS.... ✔✔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 Triostat (T3) IV Cushing's Syndrome (pg.112) - ....🔰VERIFIED ANSWERS.... ✔✔Buffalo hump, moon face, thin arms and legs, purple striae 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) - ....🔰VERIFIED ANSWERS.... ✔✔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 corticotropin or cosyntropin test. No Etomidate in RSI due to adrenal suppression. Laboratory Values Basic Metabolic Panel (BMP or CHEM7) (pg.106) - ....🔰VERIFIED ANSWERS.... ✔✔Sodium (Na+) Primary Extracellular Cation: 135-145 mEq/L [Helps nerves and muscles interact] Potassium (K+) Primary Intracellular Cation: 3.5-5.0 mEq/L MOST DANGEROUS ABNORMALITY [Responsible for cell excitability, resting membrane potential] Chloride (Cl-) Extracellular Anion 95-105 mEq/L [Maintains osmotic pressure, and helps the stomach produce HCl or Hydrochloric Acid]

Carbon Dioxide (CO2 gas) 22-26 mEq/L [Acid Base Balance contributor] BUN Blood Urea Nitrogen 6-24 mg/dL Indicates ability of Renal Clearance Cr Creatinine 0.7 -1.4 mg/dL Renal Clearance Glucose (Blood Glucose Level) 80-120 mg/dL Burns (pg. 126) - ....🔰VERIFIED ANSWERS.... ✔✔1st Degree - Sunburns 2nd Degree - Blisters "Partial Thickness" 3rd Degree - Completely Destroyed Tissue "Full Thickness) Burn Formulas (pg. 126) - ....🔰VERIFIED ANSWERS.... ✔✔Brooke

  • 2cc x kg x BSA = fluids over 24hrs (1st half in 1st 8 hrs from time of burn) Universal "Consensus Formula" - 2-4cc x kg x BSA = fluids over 24hrs (1st half in 1st 8hrs from time of burn) Parkland - 4cc x kg x BSA = fluids over 24hrs (1st half in 1st 8hr from time of burn)

Only for 2nd and 3rd degree burn types. What is the preferred burn formula? (pg. 126) - ....🔰VERIFIED ANSWERS.... ✔✔Parkland Formula is the preferred burn formula. Lactated Ringers is the preferred fluid administered. BSA Burn % Child (pg. 126) - ....🔰VERIFIED ANSWERS.... ✔✔Head and Neck - 18% Each Arm - 9% (Both Arms 18%) Each Leg - 14% (Both Arms 28%) Anterior Trunk - 18% Posterior Trunk - 18% Palmer Method: The palm represents 1% BSA in both Adults and Children. BSA Burn % Adult (pg. 126) - ....🔰VERIFIED ANSWERS.... ✔✔Head - 9% (Face 4.5%) Neck - 1% Each Arm - 9% (Both Arms 18%) Each Leg - 18% (Both Arms 36%) Anterior Trunk - 18% Posterior Trunk - 18%

Palmer Method: The palm represents 1% BSA in both Adults and Children. Average Urine Output: 30-50 mL/hr for Adults Burns >20% (pg. 126) - ....🔰VERIFIED ANSWERS.... ✔✔Possibility for Adynamic Ileus (Decreased Bowel Movement) Causes problems in-flight due to the expansion of wet gasses is restricted (Boyle's Law) Newton's 1st Law of Motion (pg. 130) - ....🔰VERIFIED ANSWERS.... ✔✔Law of Inertia Unless it is acted upon by a force, a body at rest will remain at rest and a body in motion will move at constant speed in a straight line. Newton's 2nd Law of Motion (pg. 130) - ....🔰VERIFIED ANSWERS.... ✔✔Force = Mass x Acceleration (F = M x A) When a force is applied to a body, the body accelerates, and the acceleration is directly proportional to the force applied and inversely proportional to the mass of the body. Newton's 3rd Law of Motion (pg. 130) - ....🔰VERIFIED ANSWERS.... ✔✔For every reaction there is an equal and opposite reaction.

Killers in Flight (pg.130) - ....🔰VERIFIED ANSWERS.... ✔✔Tension Pneumothorax Pericardial Tamponade Hypovolemia The most definite assessment of shock is: (pg.130) - ....🔰 VERIFIED ANSWERS.... ✔✔Lactic Acidosis (Lactate >4 mmol/L) Normal Range of Lactate 2-4 mmol/L The most commonly damaged organ in trauma is: (pg.130) - ....🔰 VERIFIED ANSWERS.... ✔✔Skin Urine Output (pg.108) - ....🔰VERIFIED ANSWERS.... ✔✔Infant 2cc/kg/hr Child 1cc/kg/hr Adult 0.5cc/kg/hr (Normal 30-50 cc/hr) 1 cc = 1 mL Spinal Shock (pg.99) - ....🔰VERIFIED ANSWERS.... ✔✔Due to the swelling of the spinal cord after trauma. Decreased Systemic Vascular Resistance SVR< Treat with IV fluids and vasopressors Can treat with high dose steroids (however, controversial)

Neurogenic Shock (pg.99) - ....🔰VERIFIED ANSWERS.... ✔✔Distributive Shock Causes a decrease in sympathetic nervous system outflow (unable to vasoconstrict or increase HR) Occurs due to spinal cord swelling after trauma Decreased Systemic Vascular Resistance SVR< However, a normal heart rate (HR normal) Hypotension, no tachycardia Warm, red skin Treat with IV fluids and vasopressors Meningitis (pg.99) - ....🔰VERIFIED ANSWERS.... ✔✔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) - ....🔰VERIFIED ANSWERS.... ✔✔The appearance of involuntary lifting of the legs when lifting the patient's head with the patient lying supine.

Kernig's Sign: (pg.99) - ....🔰VERIFIED ANSWERS.... ✔✔Severe stiffness of the hamstrings causes an inability to straighten the leg when the hip is flexed to 90 degrees. "Kicking Kernig's" Neurological Emergencies (p.92) - ....🔰VERIFIED ANSWERS.... ✔✔MAP (Mean Arterial Pressure) = SBP + (2 x DPB)/ Normal Range: 80-100 mmHg. Ideal MAP 90 mmHG. CPP (Cerebral Prefusion Pressure) = MAP - ICP Normal Range: 60-80 mmHg. Keep CPP above 60 mmHG. ICP Normal Range: 0-10 mmHg. ICP >20 mmHg has high mortality. (Monroe-Kellie Doctrine) ICP Transducer is placed at the foramen of Monro (level of ear). Signs/Sx of Herniation (pg.92) - ....🔰VERIFIED ANSWERS.... ✔✔Change in LOC Pupil Reaction Decorticate (Abnormal Flexion) Brainstem Decerebrate Posturing (Abnormal Extension) Cushing's Triad (pg.92) - ....🔰VERIFIED ANSWERS.... ✔✔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) - ....🔰VERIFIED ANSWERS.... ✔✔Paralyze (RSI) Intubate (RSI) Hyperventilate (Goal PaCO2 30-35 mmHg) Mannitol (Decrease fluid in the cranial vault, 1g/kg bolus over 5 minutes) Hypertonic Saline (Give slowly to prevent Central Pontine Myelinolysis) Barbituate 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 (Cerberyx). Phenytoin (Dilantin): 1 Gram loading dose at 50 mg/minute Lasix (Furosemide) can be used in the setting of hernation after Mannitol (but not as affective). Central Pontine Myelinolysis is caused by reversing hyponatremia too quickly. RAISIN BRAIN SHRINKAGE

What should you NOT use for treatment of Brain Herniation? (pg.93) - ....🔰VERIFIED ANSWERS.... ✔✔Do NOT use Hypotonic Solutions or Glucose! Hyponatremia is associated with cerebral edema Hyperglycemia makes brain injuries worse, most likely with cerebral edema (Swelling) Respiratory Changes in Cerebral Herniation (pg.92) - ....🔰 VERIFIED ANSWERS.... ✔✔Cheyne-Stokes: Breathing becoming shallower until it stops for a while (apnea), and then breathing starts again, rapidly cresendos to a peak before decreasing again. Pediatric Age Range (pg.88) - ....🔰VERIFIED ANSWERS.... ✔✔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) - ....🔰 VERIFIED ANSWERS.... ✔✔ETT Diameter: (16 + AGE)/ If required ETT size > or = 5.5 mm CUFFED ETT should be used. If <5.5 use an UNcuffed ETT. SUCTION INSERTION CHEST TUBE (2/3/4)

2 x ETT Size = Suction/NG Foley Diameter (EX: 5.0 ETT = 10fr Suction/NGFoley) 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) - ....🔰VERIFIED ANSWERS.... ✔✔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) - ....🔰VERIFIED ANSWERS.... ✔✔1-10 kg -> 4cc/kg/hr 10-20 kg -> 2cc/kg/hr

20 kg -> 1cc/kr/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) - ....🔰VERIFIED ANSWERS.... ✔✔D stick or BGL < 60 mg/dL Neonate 2cc/kg D Infant/Toddler 2 cc/kg D Child 2 cc/kg D Pediatric Airway Problems (pg. 89) - ....🔰VERIFIED ANSWERS.... ✔✔Stridor (Upper Airway Inhalation Problem) Wheezing (Lower Airway Inhalation Problem) Bronchiolitis (pg.89) - ....🔰VERIFIED ANSWERS.... ✔✔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) - ....🔰VERIFIED ANSWERS.... ✔✔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 Treatment with Racemic Epinephrine (aerosolized) and Steroids (Decadron). NOT usually life threatening Epiglottitis (pg.90) - ....🔰VERIFIED ANSWERS.... ✔✔Swelling of the Epiglottis Most likely bacterial causation/infection Sudden onset, DROOLING Patient presents in the "Tripod Position" Thumb Sign on lateral neck X-Ray (thumbprint) Do not disturb child due to rapid airway loss Treatment: Antibiotics, humidified O

Respiratory Syncytial Virus (pg.91) - ....🔰VERIFIED ANSWERS.... ✔✔Lower Respiratory Infection RSV can cause Apnea! More common in those with: Congenital Heart Defect (CHD), Hyaline Membrane Disease (HMD), and Bronchopulmonary Dysplasia (BPD). Treatment: Usually self-limiting. Supportive care and oxygen therapy rendered. Tocolytics (pg.77) - ....🔰VERIFIED ANSWERS.... ✔✔Drugs that CEASE uterine contractions Terbutaline (Brethine): Stops tetanic contractions of the uterus IMMEDIATELY SQ 0.25 mg q 15 minutes However, very short acting (like Succinylcholine for RSI - works fast, but not for very long). Terbutaline is also a Beta 2 Agonist used in asthma. Magnesium Sulfate "Mag" MgSO Mechanism of Action - CNS depressant, smooth muscle relaxant. Used to both prevent seizures in Pre-Eclampsia and as a tocolytic in pre-term labor. -> Loading dose 4-6 Grams IV over 30 minutes Continuous infusion rate 2 Grams/hour

Also, very long acting (like Rocuronium for RSI - takes longer to work but lasts longer). Mag toxicity can occur, do a "Mag Check" to look for decreased DTRs, Pulmonary Edema Antidote for MgSO4 is CALCIUM GLUCONATE. Premature Rupture of Membranes (PROM) (p.77) - ....🔰VERIFIED ANSWERS.... ✔✔A mother's "water breaks", and signifies that delivery is imminent. If this occurs and the baby is preterm you must PREPARE FOR DELIVERY! The amniotic sac (membrane) surrounding the baby protects it from infection (sepsis). Administer steroids to stimulate fetal lung maturity! Pre-Eclampsia (pg.80) - ....🔰VERIFIED ANSWERS.... ✔✔HTN/Proteinuria/Edema NO SEIZURES Risk Factors - Extremes of Age, 1st Pregnancy Often causes late decelerations Eclampsia (pg.80) - ....🔰VERIFIED ANSWERS.... ✔✔HTN/Proteinuria/Edema GENERALIZED SEIZURES Seizures are treated with Valium/Diazepam

Give MgSO4 to depress seizure activity ->Signs of Mag toxicity is decreased DTRs (hyporeflexia), pulmonary edema ANTIDOTE for MgSO4 Calcium Gluconate Maternal Hemorrhage (pg.80) - ....🔰VERIFIED ANSWERS.... ✔✔EMERGENCY - Placenta Abruption "painful" bleeding. Any MVA or blunt trauma is this DX. until ruled out. Causes exsanguination & placental insufficiency NON-EMERGENCY - Placenta Previa painless, bright red bleeding. No vaginal exam! Postpartum Hemorrhage (PPH) >500mL blood loss Vigorous fundal massage! Bimanual uterine compression Pitocin (pg.80) - ....🔰VERIFIED ANSWERS.... ✔✔Drug that causes contraction of the uterus to help stop bleeding. Synthetic Oxytocin Often used for uterine atony (loss of muscle strength) after placental delivery in the setting of continued maternal hemorrhage. Methergine (pg.80) - ....🔰VERIFIED ANSWERS.... ✔✔Drug that causes contraction of the uterus to help stop bleeding.

Oxytocin (pg.81) - ....🔰VERIFIED ANSWERS.... ✔✔Released by the pituitary gland in large amounts; After distention of the cervix, and uterus during labor, facilitating birth. After stimulation of the nipples. During breastfeeding. (This is one reason why babies are placed on mother's chest after birth). Uterine Rupture (pg.81) - ....🔰VERIFIED ANSWERS.... ✔✔Spontaneous tearing of the uterus "Stomach is as hard as a board" Caused by peritonitis. "Fetal parts presenting under the mother's skin" #1 cause of maternal death is trauma #1 cause of fetal death is maternal death Rh Negative Mothers (Rh=) (pg.81) - ....🔰VERIFIED ANSWERS.... ✔✔Rhogam prevents mother's immune response to the baby's Rh+ (positive) cell - prevents the mother's immune system from attacking the baby. Occurs with the second pregnancy. If a mother is Rh= (negative), ALWAYS administer Rhogam. Rhogam 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 Rhogam 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) - ....🔰VERIFIED ANSWERS.... ✔✔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 macrosomia). 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) - ....🔰VERIFIED ANSWERS.... ✔✔Condition vs. Treatment HTN = Labetolol, 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) - ....🔰VERIFIED ANSWERS.... ✔✔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, DeLee Suction, or 10fr or 14 fr suction catheters. Airways secretion and edema causes serious problems earlier than in adults. Consider nagogastric tubes in all intubated neonates. Meconium (pg.83) - ....🔰VERIFIED ANSWERS.... ✔✔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) - ....🔰VERIFIED ANSWERS.... ✔✔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) - ....🔰VERIFIED ANSWERS.... ✔✔Top 3 Killers in the 1st 24hrs

  1. Sepsis (Groub B Streptococcus Infection TX:AMP-GENT)
  2. Respiratory Complications
  3. Cardiac Problems Tetralogy of Fallot (pg.87) - ....🔰VERIFIED ANSWERS.... ✔✔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). "Tet Spells" sudden cyanosis and syncope TX: Knees to chest, Morphine further tx. perform RSI, Intubate, and 100% O2. Miscellaneous Neonatal Information (pg. 87) - ....🔰VERIFIED ANSWERS.... ✔✔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.