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Critical Care Transport/Flight Paramedic: Complete Questions and Answers, Exams of Nursing

A comprehensive set of questions and answers related to critical care transport and flight paramedicine. It covers various topics, including physiology, gas laws, hypoxia, and vascular access devices. Designed to help students prepare for exams or refresh their knowledge in this field.

Typology: Exams

2024/2025

Available from 11/04/2024

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Sickled cells ✔✔Red blood cells that are less deformable and do not pass through microcirculation as easily, cause an increase in blood viscosity, and are sequestered and destroyed by the liver and spleen Acute chest syndrome ✔✔Condition that accounts for 25% of premature deaths in patients with sickle cell disease; the leading cause of hospitalization and death of sickle cell patients; symptoms include fever, cough, chest pain, dyspnea, new infiltrates on chest x-ray; no definitive therapy, only supportive care Integrin, Roero, and Aggrastat ✔✔The three glycoprotein IIb/IIa inhibitors that bind to a platelet receptor glycoprotein and inhibit platelet aggregation 760 mmHg/1 atm ✔✔Barometric pressure at sea level Physiologic zone ✔✔Atmospheric zone; sea level-10,000 ft; human body is well adapted; adequate pressure to allow for oxygen exchange, impairments are frequently due to changes in pressure (ascent or descent) Physiologically deficient zone ✔✔Atmospheric zone; 10,000-50,000 ft; noticeable deficits to humans; reduced barometric pressure results in poor oxygen exchange; most noticeable impairment is hypoxia (trapped gases can also cause hypoxia) Space equivalent zone ✔✔Atmospheric zone; 50,000-250,000 ft; environment incompatible with human life; pressurized suits and sealed cabins required; impairments include hypoxia, trapped gas, and emboli Boyle's Law ✔✔Gas law; When temperature remains constant, the volume of a gas is inversely proportional to its pressure; As a gas bubble ascends, it expands. As it descends, it gets smaller; P1(V1) = P2(V2) Charles' Law ✔✔Gas law; At a constant pressure, the volume of gas is directly proportional to its temperature; For every 1,000 ft (333 meters) of altitude increase, temperature decreases 2 degrees Celsius; V1/T1 = V2/T Ideal Gas Law ✔✔Gas law; created to explain Boyle's Law vs. Charles Law; It takes a large amount of temperature change to affect a small amount of volume; pV = nRT (absolute pressure of gas x volume = amount of substance x gas constant x absolute temperature) Dalton's Law ✔✔Gas law; The total pressure of a gas mixture is the sum of the individual partial pressure of all the gas in the mixture; As altitude increases, the amount

of oxygen molecules decreases, but the percentage of molecules remains the same; Pt = P1 + P2 + P3... (Pt = total pressure of a gas) Henry's Law ✔✔Gas law; The amount of gas in a solution is proportional to the partial pressure of gas in contact with the liquid; decompression sickness: increased nitrogen absorbed into the blood at depth, nitrogen "bubbles" exit the blood with rapid change in air pressure; soda bottle: CO2 held in suspension by pressure, lid is removed and CO exits to equalize with atmospheric pressure; P = KHC Graham's Law ✔✔Gas law; With temperature and pressure held constant, the relative rate of diffusion of a gas is inversely proportional to the square roots of the density of those gases; The less dense the gas, the more rapidly the gas will diffuse through the air; Lighter gases diffuse more rapidly in narrowed peripheral airways (heliox); CO2 has a solubility factor 19 times greater than O2 and will more rapidly diffuse across a membrane 15 PSI/1 atm ✔✔Amount of pressure at 33 ft of ocean depth indifferent stage ✔✔first of the four stages of hypoxia; sea level to 10,000 ft in altitude; 33,000- 3 9,000 ft if breathing 100% oxygen; SpO2 of 90-95%; night vision lost 5,000 ft; slight increase in heart rate and respiratory rate compensatory stage ✔✔second of the four stages of hypoxia; 10,000-15,000 ft in altitude; 39,000-42,000 ft if breathing 100% oxygen; SpO2 80-90%; signs and symptoms include deceased alertness, subtle errors in judgement, fatigue, irritability, headache, tachycardia, tachypnea, increased blood pressure, increased tidal volume, altered mental status disturbance stage ✔✔third of the four stages of hypoxia, 15,000-20,000 ft in altitude; 42,000-45,200 ft if breathing 100% oxygen; SpO2 70-80%; signs and symptoms include fatigue, dizziness, cyanosis, impairment, tachypnea, altered mental status, impaired central and peripheral vision, and personality changes; period of useful consciousness is 15-20 minutes critical stage ✔✔last of the four stages of hypoxia; 20,000-23,000 ft in altitude, 45,200- 46,800 ft if breathing 100% oxygen; SpO2 60-70%; signs and symptoms include severe altered mental status, seizures, impairment, unconsciousness, severe mental and physical capacitation, and death hypoxic hypoxia ✔✔one of the four types of hypoxia; inadequate oxygenation secondary to reduced partial pressures of oxygen in inspired air; caused by reduced PaO2, impaired gas exchange across the alveolar-capillary membrane, or impaired ventilation

anemic (hypemic) hypoxia ✔✔one of the four types of hypoxia; inadequate tissue oxygenation secondary to reduced to reduced oxygen-carrying capacity (from either inadequate availability of oxygen molecules or obstructive pathology that prevents oxygen from diffusing across alveolar membranes); caused by CO poisoning, anemia, blood loss, drugs causing methemoglobinemia, alcohol use or abuse, COPD, pneumonia, pulmonary edema, or pulmonary embolism stagnant hypoxia ✔✔one of the four types of hypoxia; inadequate tissue oxygenation secondary to reduced cardiac output, pooling of blood, reduced blood flow to tissues, or restriction of blood flow; cause by heart failure, shock, gravitational forces, positive pressure ventilation, or pulmonary embolism histotoxic hypoxia ✔✔one of the four types of hypoxia; inadequate tissue oxygenation secondary to metabolic disorder or poisoning of the cytochrome oxidase enzyme system resulting in cellular inability to utilize oxygen; caused by toxic gas poisoning, alcohol or narcotic abuse, or cyanide poisoning temperature ✔✔the "vital sign" should be monitored on ALL patients during flight, especially pediatric patients 30 degrees ✔✔angle at which the patient's head should be raised on the stretcher in most cases, especially intubated patients and patients with head injuries rotor-wing aircraft ✔✔type of aircraft typically used for transports less than 150 nautical miles; operates at sustained speeds of 100-200 mph and at altitudes less than 10,000 ft fixed-wing aircraft ✔✔type of aircraft typically used for transports over 150 nautical miles; operates at speed ranges from 300-600 mph and at altitudes up to 38,000 ft Part 91 ✔✔the section of Title 14 of the Code of Federal Regulations that governs the operation of all aircraft within the U.S., including the waters within 12 nautical miles of the U.S. coast; can only be used when NO medical crew is on board Part 135 ✔✔the section of Title 14 of the Code of Federal Regulations that governs all commuter or on-demand commercial flight operations; contains strict weather minimums and duty times; requires that pilots have no more than 14 hours of duty time followed by at least 10 hours of rest; must be used when a medical crew is on board Crew Resource Management (CRM) ✔✔one solution that has been implemented to reduce the number of air medical accidents defined as using all available resources (information, equipment, and people) to achieve safe and efficient flight operations; focuses on the cognitive and interpersonal skills needed to successfully complete the flight

therapeutic misadventure ✔✔implies death that occurs as a result of unexpected complications of medical procedures; a "nice" term for a medical mistake dialysis fistula ✔✔a dialysis site that is formed by surgically connecting the walls of an artery to the walls of a vein; takes three to six months to mature dialysis graft ✔✔a dialysis site that is created by connecting the artery and the vein with a synthetic tube; takes two to six weeks to mature PICC (peripherally inserted central catheter) ✔✔non-tunneled CVAC (central venous access catheter) that is popular in patients who require intermediate to long-term, as well as short-term, venous access; the most popular form of vascular access in NICU patients; commonly composed of biocompatible materials and come in a variety of sizes; can have multiple lumina; used for TPN, chemotherapy, blood products, blood sampling, fluid and drug administration, and measuring CVP (central venous pressure) Hickman Catheter ✔✔tunneled CVAC (central venous access catheter) used for long- term use in the cephalic, subclavian, internal jugular, or external jugular vein; has thromboresistant lumina made of polymeric silicone and are available in double and triple catheters; frequent heparin flushes required Broviac Catheter ✔✔tunneled CVAC (central venous access catheter) that is typically used for pediatric patients for long-term use of TPN, IV fluids, and medications; lumina made of polymeric silicone and are available in double and triple catheters; needs to be flushed once daily to once weekly when not in use and must be heparinized; injection cap should be changed every seven days or after 18 needle insertions, after the cap has been removed, if it appears damaged, or after a blood draw Groshong Catheter ✔✔tunneled CVAC (central venous access catheter) that has a long, hollow lumen made of soft silicone, and has a closed, rounded tip and a three- position valve placed in the side of the catheter near the tip, which allows fluid to flow in or out, but remain closed when not in use; inserted into the jugular vein and advanced into the superior vena cava; heparin not required; daily flushing required SVAD (subcutaneous vascular access device) ✔✔tunneled CVAC (central venous access device) that has an injection port, wherein the port itself includes a self-closing septum for repeated injections; also known as a port-a-cath; requires a special non- coring injection needle called a Huber needle; used for long-term IV antibiotic or anti fungal treatment, chemotherapy, TPN, repeated blood samples, and hemodialysis arterial line ✔✔central line placed for continuous beat-by-beat blood pressure measurement and frequent arterial blood gas analysis; waveform should be displayed and monitored at all times; 25% incidence rate of occlusion, in which 3% of these result in permanent occlusion; 20 gauge catheter used in adults, 22 gauge catheter used in children, and 24 gauge catheter used in infants

dampening ✔✔distortion of an arterial line waveform, which can lead to inaccurate systolic and diastolic blood pressures (typically lower than they actually are); caused by any restriction in transmission of the arterial pressure to the transducer; can occur as a result of blood clots in the system, kinking of the tubing, compression of air bubbles, viscous drag of saline in the line, or patient may actually be hypotensive Type and Cross ✔✔test in which the patient's blood is mixed with a potential donor's blood under a microscope to test for compatibility (if blood is not compatible, it will agglutinate [clump together]); takes up to 45 minutes to complete Type and Screen ✔✔test that assesses a patient's blood type and antibodies; takes approximately 15 minutes to complete normal saline ✔✔What is the only solution that blood products can be administered with? endotoxemia ✔✔potentially fatal reaction caused by gram-positive or gram-negative bacterial contamination during a transfusion of blood products due to poor aseptic technique or subacute bacteremia at the time of donation; symptoms are identical to septic shock TRALI (transfusion-related acute lung injury) ✔✔non-cariogenic pulmonary edema secondary to a blood transfusion; occurs in one out of every 5,000 transfusions; most frequent in multiparous females or multi-transfused patients; unpredictable and unpreventable; more frequent with plasma and platelet administration than other blood products; most patient recover with 48 hours of appropriate ventilator therapy and hemodynamic support TACO (transfusion-related circulatory overload) ✔✔volume overload and pulmonary edema secondary to a blood transfusion; patients with decreased ejection fraction or renal disease at greater risk; prevented by good assessment, limiting number of units administered per day if not actively hemorrhaging, decreasing infusion rate, and furosemide administration between units massive transfusion ✔✔a blood transfusion in which ten or more units are administered in a 24 hour period; hyperkalemia is a probable side effect due to shelved blood becoming acidic; hypocalcemia is a probably side effect due to added citrate in the donor blood, which binds to calcium; patients with impaired kidneys will benefit from "fresher" blood; other complications include ammonia intoxication, DIC, thrombocytopenia, hypothermia, ARDS, etc. diaphragm ✔✔structure in the body responsible for 75% of tidal volume during normal, quiet breathing

PaO2 (partial pressure of oxygen) ✔✔the measurement of the amount of oxygen in the blood available for use by the body; normal level is 80-100; should be approximately five times the percentage of oxygen a person is inhaling 2,3-DPG (Diphosphoglycerate) ✔✔isomer made by red blood cells in normal amounts during homeostasis; acts as a crowbar to offload oxygen from the hemoglobin; will increase or decrease production according to body conditions; when increased, there is less ability for hemoglobin to hold onto oxygen and more ability to release it into tissues; when decreased, there is more ability for hemoglobin to hold onto oxygen and less ability to release it into tissues 4 ✔✔How many oxygen carrying sites are on each hemoglobin molecule? oxyhemoglobin dissociation curve ✔✔Relationship between available oxygen and amount of oxygen carried by hemoglobin; The first part of the graph is relatively flat, indicating the difficulty of attaching the first oxygen molecule to the heme subunit of the hemoglobin; The middle of the graph is steep, a result of the increased ease of oxygen binding as the second, third, and fourth oxygen molecules are bound to the heme subunits; The lower portion of the curve represents the condition found in metabolically active tissue; The upper portion of the curve represents the condition in the pulmonary vasculature at the alveolar-capillary membrane. right shift ✔✔the direction in which the oxyhemoglobin dissociation curve is shifted when more oxygen is released from the hemoglobin, resulting in greater oxygen delivery to the tissues; caused by increased PCO2, increased temperature, increased 2,3-DPG (less ability for hemoglobin to hold onto oxygen), and decreased pH (acidosis); Ex: SpO2 of 80 (low) with a paO2 of 80 (normal)

  • raised PCO
  • raised temperature
  • raised 2,3-DPG
  • raised acidity (acidosis left shift ✔✔the direction in which the oxyhemoglobin dissociation curve is shifted when oxygen is released by hemoglobin at significantly lower PaO2, resulting in decreased oxygen delivery; caused by decrease in PCO2, decreased temperature, decreased 2,3- DPG (not enough to offload oxygen), increased pH (alkalosis), and carbon monoxide poisoning; Falsely high SpO2 readings will not match PaO
  • lowered PCO
  • lowered temperature
  • lowered 2,3-DPG
  • less acidity (alkalosis) < (or equal to) 22 seconds ✔✔Normal thrombin time

V/Q ratio ✔✔The balance between the ventilation (bringing oxygen into the alveoli and removing CO2 from the alveoli) and the perfusion (removing oxygen from the alveoli and adding CO2) V/Q mismatch ✔✔Most common cause of respiratory failure; an imbalance between ventilation and perfusion Low V/Q (mismatch) ✔✔V/Q mismatch in which there is poor ventilation but adequate blood flow; Alveoli aren't inflated to capacity in order to exchange gas; Healthier alveoli can compensate for CO2 but not O2; "shunt perusion" High V/Q (mismatch) ✔✔V/Q mismatch in which there is adequate ventilation, but poor perfusion; Alveoli are well ventilated and inflates; Oxygen dissociation curve is flat at normally high levels; "dead space" ventilation chronic emphysema ✔✔chronically progressive disease defined by permanent enlargement of the air spaces distal to the terminal bronchioles including destruction of the alveolar walls (results in decreased surface area), partial collapse of terminal bronchioles (results in air-trapping), and loss of elastic recoil (results in decreased alveolar recruitment); pulmonary capillary bed destroyed by enzyme activity; Patients may always be hypercapnic, have increased risk of respiratory infections, commonly develop pulmonary hypertension (which leads to hypoxia), and commonly develop CHF chronic bronchitis ✔✔defined clinically as the presence of a productive cough for three months out of the year for two years in a row; Chronic irritation results in hyperplasia of the tracheobronchial mucous glands and goblet cells, bronchoconstriction, and destruction of cilia; Patients have increased risk of pneumonia and CHF PaO2 > 60 mmHg; SpO2 > 90% ✔✔When treating COPD, treatment is aimed at achieving what PaO2 and what SpO2? (If these are not maintained, patient may need to be intubated.) pulmonary embolus ✔✔the occlusion of the pulmonary artery or one or more of its branches by a clot carried through the blood stream; second most common cause of sudden unexpected natural death at any age; Risk factors include hypercoagulability, venous stenosis, venous injury, trauma, or surgery; diagnosis unsuspected until autopsy in up to 80% of cases; About 10% of patients will die in the first hour; 30% of patients who survive will die from a recurrent episode. assessment ✔✔What is the most important prehospital aspect in providing a differential diagnosis of a pulmonary embolism? CT scan (or CT angiography) ✔✔the "gold standard" in diagnostic testing for a pulmonary embolism

ARDS (Acute Respiratory Distress Syndrome) ✔✔hyperacute inflammatory response in which the body releases harmful chemicals which cause inflammation in the lungs; can be secondary to any condition that produces a systemic inflammatory response (most commonly sepsis); does not respond to steroids; Treatment includes treating the underlying cause, supporting the respiratory system, and allowing time to heal; may appear on a chest x-ray as "ground glass," "wet lung," or "diffuse pulmonary infiltrates in all lobes" Process

  • capillaries leak
  • localized vasodilation
  • WBC's respond to interstitial space
  • pulmonary edema
  • decreased surfactant
  • lungs develop scar tissue
  • decreased lung compliance and poor gas exchange Mild ARDS ✔✔severity of ARDS (acute respiratory distress syndrome) in which PaO2/FiO2 is less than or equal to 300 but greater than 200 Moderate ARDS ✔✔severity of ARDS (acute respiratory distress syndrome) in which PaO2/FiO2 is less than or equal to 200 but greater than 100 Severe ARDS ✔✔severity of ARDS (acute respiratory distress syndrome) in which PaO2/FiO2 is less than 100 Wean (patient from ventilator ASAP) Hand Hygiene Aspiration Prevention (oral hygiene, suction, 30 degrees sitting angle) Prevent Contamination ✔✔Acronym WHAP; "VAP" bundle; used to prevent ventilator acquired pneumonia Fluctuation (normal with respirations if lung is still collapsed) Output Color Air Leaks Levels (adequate water levels; proper negative pressure levels) ✔✔Acronym FOCAL; used to assess the drainage system of a chest tube CAD (Coronary Artery Disease) ✔✔the single leading cause of death for both men and women in the U.S.

right coronary artery ✔✔This coronary artery supplies the anterior right ventricle, inferior wall of the left ventricle, posterior left ventricle, and posterior third of the septum; if occluded, can cause inferior MI, posterior MI, or right-sided MI left anterior descending artery ✔✔This coronary artery supplies the anterior left ventricle, two thirds of the intraventricular septum, and the apex of the left ventricle; if occluded, can cause anterior MI, anterolateral MI, anteroseptal MI, or septal MI left circumflex artery ✔✔This coronary artery supplies the posterior wall of the left ventricle and the left atrium; if occluded, can cause anterolateral MI, lateral MI, septal MI, or posterior MI automaticity; excitability; conductivity; contractility ✔✔the four characteristics of myocardial cells automaticity ✔✔the ability of a single cardiac cell to contract rhythmically at a steady rate without input; If two cardiac muscle cells are in contact, the first one to contract will in turn stimulate the other to contract and so forth. excitability ✔✔refers to the ease with which cardiac cells undergo a series of events characterized by sequential depolarization and repolarization, communication with adjacent cells, and propogation if the electrical activity in a normal or abnormal manner conductivity ✔✔the intrinsic ability of the cardiac cells to conduct electrical impulses contractility ✔✔the intrinsic ability of the heart muscle to contract to given length; the capacity for the fibers to become shorter in response to an electrical stimulus systole ✔✔the stage of the cardiac cycle in which depolarization occurs; Sodium and calcium move into the cells. diastole ✔✔the stage of the cardiac cycle in which repolarization occurs; Sodium channels are closed, potassium flows out of the cells, and calcium channels are closed. isovolumetric relaxation ✔✔the stage of the cardiac cycle in which relaxation occurs and ventricular pressure decreases, but volume does not change (because the semilunar valves have closed an the AV valves have not opened yet) preload ✔✔the stretch on the myofibril at the end of diastole; allows for filling of the ventricles Frank-Starling's Law ✔✔the law that states the degree to which a myocardial cell is stretched in diastole determines the velocity and force of the contraction; Greater preload means greater stroke volume, and thus, greater cardiac output.

afterload ✔✔the pressure or initial resistance that must be overcome by the ventricles to open the pulmonic and aortic valves and eject blood into systemic circulation; systemic vascular resistance = 800 - 1200 dynes/sec/cm^ 800 - 1200 dynes/sec/cm^5 ✔✔systemic vascular resistance (amount) heart rate; preload; after load; contractility ✔✔the four determinants of cardiac output stroke volume ✔✔the amount of blood ejected by the ventricles with each contraction; normal is 60-130 mL per beat for an average adult; a function of preload, afterload, and contractility 60 - 130 mL ✔✔normal stroke volume per beat for the average adult 70 - 100 mmHg ✔✔normal MAP (mean arterial pressure) range [(2 x diastolic) + systolic] / 3 ✔✔MAP (mean arterial pressure) formula MAP (mean arterial pressure) ✔✔a measurement of the constant pressure in the arteries; normal is 70 - 100 mmHg; formula to determine this is [(2 x diastolic) + systolic] / 3 left heart catheterization ✔✔catheterization aimed at diagnosis and treatment of structural and functional anomalies; also used for interventional procedures; catheter inserted into a central artery proximal lumen ✔✔the blue lumen of a Swan-Ganz catheter; opening is located 30 cm from the distal tip of the catheter; measures CVP (central venous pressure) which is the pressure in the right atrium; injectate port for measuring cardiac output distal lumen ✔✔the yellow lumen of a Swan-Ganz catheter; opening is located at the distal tip of the catheter; measures PAP (pulmonary artery pressure) balloon inflation port ✔✔the red port of a Swan-Ganz catheter; located at the tip of the catheter; inflated to advance the catheter during insertion and to wedge the catheter when in the pulmonary artery; 1.5 mL special syringe required; has a safety on it, which should be engaged during transport infusion port ✔✔the white or clear port of a Swan-Ganz catheter; used for fluid infusion intracardiac pacing lumen ✔✔the lumen of a Swan-Ganz catheter that allows for atrial and ventricular pacing; opening is located in the right atrium or the right ventricle;

monitors SvO2 (venous oxygen saturation); can be fiberoptic; is not present on all Swan-Ganz catheters Swan-Ganze catheter (pulmonary artery catheter) ✔✔right heart catheterization; four lumen, flexible, balloon tip catheter that is inserted into a central vein (usually the subclavian) and sits in the left atrium (after being threaded through the right atrium and right ventricle); used to measure pulmonary artery pressures; one third of these catheters lead to infection; risks of trauma or structural damage to the heart, arrhythmias, emboli, and CVA; no longer commonly seen in transport phlebostatic axis ✔✔the location on the body in which the stopcock for the transducer of a Swan-Ganz catheter or an arterial line must be zeroed at for accurate readings; If lower than this location, readings will be inaccurately high, and if higher than this location, readings will be inaccurately low. autoregulation ✔✔the ability of tissue to regulate its own blood supply; If tissue is inadequately oxygenated, hypoxia and metabolites accumulate including, lactic acid, which stimulates vasodilation. Onset Location Duration Character Activity Aggravating Factors Alleviating Factors Radiation ✔✔Acronym OLDCAAAR; used to gain a history and physical exam 45 degrees ✔✔angle at which a patient must be sitting to assess for JVD (jugular venous distention) pulsus alternans ✔✔a pulse that alternates strength with every other beat pluses paradoxus ✔✔a pulse that disappears during inspiration but returns during expiration Beck's Triad ✔✔the clinical term for hypotension, muffled heart tones, and JVD (jugular venous distention); may occur in patients who have cardiac tamponade, especially from sudden intrapericardial hemorrhage Stage I ✔✔stage of pericarditis in which anterior and inferior leads on a 12-lead ECG show concave ST-segment elevation and PR segment deviations are opposite to P polarity

Stage II ✔✔stage of pericarditis in which there will first be a deviated PR on the 12-lead ECG and ST junctions return to baseline; Late in this stage, T waves progressively flatten and invert. Stage III ✔✔stage of pericarditis in which T waves are inverted in almost all leads on the 12-lead ECG Stage IV ✔✔stage of pericarditis in which the 12-lead ECG returns to its pre-pericarditis state true aneurysm ✔✔an aortic aneurysm that involves all three layers of the blood vessel wall (fusiform and saccular) false aneurysm ✔✔an aortic aneurysm that is contained by the two outer layers of the blood vessel and clot A wave ✔✔the wave produced on a monitor for an arterial line catheter when the atria contract; should be compared with ECG monitoring X and Y waves ✔✔the waves produced on a monitor for an arterial line catheter during atrial diastole C wave ✔✔the waves produced on a monitor for an arterial line catheter with the closure of the tricuspid valve V wave ✔✔the wave produced on a monitor for an arterial line catheter with left ventricular contraction (when wedged, comes from the right ventricular contraction) RVP (right ventricular pressure) ✔✔the pressure in the right ventricle; measurement taken only during insertion of a Swan-Ganz catheter; normal systolic value is 15 - 30 mmHg; normal diastolic value is 0 - 8 mmHg; can be elevated due to pulmonary disease, hypoxemia, CHF, right ventricular failure or infarction or ventricular septal defect; can be decreased due to hypovolemia or vasodilation 15 - 30 mmHg ✔✔normal systolic value of the RVP (right ventricular pressure) 0 - 8 mmHg ✔✔normal diastolic value of the RVP (right ventricular pressure) PAP (pulmonary artery pressure) ✔✔the pressure in the pulmonary artery with the Swan-Ganz catheter balloon deflated; measured through the distal port of the catheter; normal systolic value of 15 - 30 mmHg; normal diastolic value of 5 - 15 mmHg; can be elevated due to hypervolemia, pulmonary hypertension, positive pressure ventilation, cardiac tamponade, or left ventricular failure; can be decreased due to hypovolemia or vasodilation

15 - 30 mmHg ✔✔normal systolic value of the PAP (pulmonary artery pressure) 5 - 15 mmHg ✔✔normal diastolic value of the PAP (pulmonary artery pressure) PAWP (pulmonary artery wedge pressure) [also known as PCWP (pulmonary capillary wedge pressure) or PAOP (pulmonary artery occlusion pressure)] ✔✔the pressure achieved by wedging a Swan-Ganz catheter; balloon is only inflated with up to 1.5 mL of air and allowed to wedge into the distal branch of the pulmonary artery, where it is too narrow for the balloon to pass; balloon cannot be overinflated and can not be inflated for more than 15 seconds; normal value is 4 - 12 mmHg; value should be lower than the mean pulmonary artery pressure and the pulmonary artery diastolic pressure 4 - 12 mmHG ✔✔normal PAWP (pulmonary artery wedge pressure) hypertensive urgency ✔✔severe elevation in blood pressure (systolic of greater than or equal to 180 and diastolic of greater than or equal to 120) with no signs of acute end- organ damage; blood pressure should be lowered within a few hours to a few days using oral or IV medications hypertensive emergency ✔✔severe elevation in blood pressure (systolic of greater than or equal to 180 and diastolic of greater than or equal to 120) with signs of acute end- organ damage; blood pressure should be lowered within a few hours using IV medications 10% - 20% in the first hour, then 25% over the next 24 hours ✔✔the goal decrease in MAP in hypertensive patients; Exceptions are spontaneous subarachnoid hemorrhage and aortic dissection, in which more aggressive treatments warranted onset ✔✔If the PAWP (pulmonary artery wedge pressure) is 18 - 20 mmHG, what level of pulmonary congestion is present? moderate ✔✔If the PAWP (pulmonary artery wedge pressure) is 21 - 25 mmHG, what level of pulmonary congestion is present? severe ✔✔If the PAWP (pulmonary artery wedge pressure) is 26 - 30 mmHG, what level of pulmonary congestion is present? acute pulmonary edema ✔✔If the PAWP (pulmonary artery wedge pressure) is greater than 30 mmHG, what level of pulmonary congestion is present? cardiac output ✔✔the amount of blood ejected by the ventricle each minute; evaluates cardiac function; calculated by stroke volume x heart rate; normal range is 4 - 8 L/min for the average adult; increased by sympathetic nervous system stimulation, positive

inotropic stimulation, hyperthyroidism, hypervolemia, anemia, or catecholamine administration stroke volume x heart rate ✔✔cardiac output formula 4 - 8 L/min ✔✔normal cardiac output range in the average adult cardiac index ✔✔cardiac output / BSA (body surface area); normal range is 2.5 - 4 L/m/m^2; in cariogenic shock, value will fall below 1.8 L/min/min^ cardiac output / BSA (body surface area) ✔✔cardiac index formula 2.5 - 4 L/m/m^2 ✔✔normal cardiac index range in the average adult SvO2 (mixed venous oxygen saturation) ✔✔the amount of hemoglobin saturated with oxygen; monitors the balance and provides an "early warning" system between oxygen supply and demand; normal range is 60% - 80%; reflection of how well the tissues' demand for oxygen is being met 60% - 80% ✔✔normal SvO2 (mixed venous oxygen saturation) range oxygen supply/demand mismatch ✔✔caused by decrease in cardiac output leading to decreased oxygen supply to the tissues, decreased oxygen content resulting in less oxygen being supplied to the tissues, decreased hemoglobin availability, or inability of oxygen to leave hemoglobin first stage ✔✔stage of compensatory response to decreased SvO2 (mixed venous oxygen saturation) in which there is increased cardiac output, and oxygen delivery can be increased by 400 - 600% second stage ✔✔stage of compensatory response to decreased SvO2 (mixed venous oxygen saturation) in which tissues extract more oxygen than normal from the blood; "red flag" indicating changes are about to occur in patient's clinical condition third stage ✔✔stage of compensatory response to decreased SvO2 (mixed venous oxygen saturation) in which anaerobic metabolism occurs, leading to the production of lactic acid; Metabolic acidosis ensues. 2 - 6 mmHG ✔✔normal CVP (central venous pressure) range; normal RAP (right atrial pressure) range LVP (left ventricular preload) ✔✔the pressure in the left ventricle at the end of ventricular filling; directly correlated to the LAP (left atrial pressure); same as the

LVEDP (left ventricular end diastolic pressure); indirectly measured by PAWP (pulmonary artery wedge pressure) right ventricular preload ✔✔the pressure in the right ventricle at the end of ventricular filling; directly correlated to the pressure in the right atrium; the same as CVP (central venous pressure) and is 2 - 6 mmHg PVR (pulmonary vascular resistance) ✔✔a calculated value based on mean PAP (pulmonary artery pressure) and PAWP (pulmonary artery wedge pressure); used as a clinical indicated of right ventricular afterload; normal value of < 250 dynes/sec/cm^ < 250 dynes/sec/cm^5 ✔✔normal PVR (pulmonary vascular resistance) range SVR (systemic vascular resistance) ✔✔a calculated value based on MAP (mean arterial pressure) and CVP (central venous pressure); (MAP - CVP) / CO; used as a clinical indicator of left ventricular afterload; normal value of 800 - 1200 dynes/sec/cm^ 800 - 1200 dynes/sec/cm^5 ✔✔normal SVR (systemic vascular resistance) range systolic heart failure ✔✔type of heart failure in which the left ventricle is unable to pump adequately; results in a decrease in stroke volume diastolic heart failure ✔✔type of heart failure in which the left ventricle cannot relax or fill completely, but there is a normal ejection fraction; results in a decrease in stroke volume stable angina ✔✔most common type of engine; usually predictable in onset and in nature; usually occurs during exertion, severe emotional distress, or after eating a heavy meal; symptoms usually last less than five minutes unstable angina ✔✔less common form of angina and more severe in nature; symptoms are more severe and less predictable in nature; pain is more frequent, lasts longer, occurs at rest, and is not relieved by medication variant (Prinzmetal's) angina ✔✔form of angina caused by spasms of the coronary arteries; occurs spontaneously, and nearly always at rest; attacks can be very painful; most attacks occur during sleep and wake the patient up microvascular angina ✔✔form of angina resulting from dysfunction of the arteries supplying blood to the heart, arms, and legs; used to describe angina found in patients with normal coronary angiograms hemostasis ✔✔the balance between hemorrhaging and thrombosis; components include vascular integrity, platelet function, coagulation factors, and fibrinolysis

fibrinolysis ✔✔dissolution of fibrin clots as vascular injury is repaired; in excess, disrupts coagulation cascade by altering coagulation factors or inducing excessive consumption of factors CVP (central venous pressure) ✔✔the pressure in the venous system; can be measured with a pressure transducer or a water manometer; reflects right ventricular end diastolic pressure or preload; normal value are 2 - 6 mmHg; can be elevated due to right heat failure, cardiac tamponade, pulmonary hypertension, volume overload, or positive pressure ventilation; can be decreased due to volume depletion, vasodilation, venous vasodilators, or endogenous system vasodilators (such as nitric oxide) RAP (right atrial pressure) ✔✔the pressure in the right atria, measured through the proximal port of the Swan-Ganz catheter; reflects right ventricular end diastolic pressure or preload, similar to the CVP (central venous pressure); normal values are 2 - 6 mmHg; can be elevated due to right heart failure, cardiac tamponade, pulmonary hypertension, volume overload, or positive pressure ventilation; can be decreased due to volume depletion, vasodilation, venous vasodilators, or endogenous system vasodilators (such as nitric oxide) air ✔✔What substance on a radiograph image is black? blood ✔✔What substance on a radiograph image is white if accuse and gray to black if old? bone ✔✔What substance on a radiograph image is white to light gray? gray ✔✔What color are muscle, organs, and fat on a radiograph image? projection ✔✔The farther a structure is from the film, the larger it will be on the film in a radiographic image. Airway Bony Thorax Cardiac Silhouette Diaphragm Effusion Fields (Lung) Gastric Bubble Hilum Invasive Devices and Lines ✔✔the "A - I" approach to evaluate a chest x-ray Hilum ✔✔the location in which nerves and vessels supply an organ 3 - 7 cm ✔✔A properly placed endotracheal tube should be how far, in distance, superior to the carina (visible on a chest x-ray) in the average adult?

50% ✔✔What percentage (or less) should the transverse diameter of the cardiac silhouette be, of the transverse diameter of the thoracic cage on a chest x-ray? intraparenchymal hemorrhage ✔✔a type of brain hemorrhage in which the CT scan will show white areas within the brain tissue itself; cerebral hemorrhage subarachnoid hemorrhage ✔✔a type of brain hemorrhage in which the CT scan will show white areas in the sulci; star films; may have the appearance of a star or a spider epidural hemorrhage ✔✔a type of brain hemorrhage in which the CT scan will show a white convex shape; may have the appearance of a contact lens subdural hemorrhage ✔✔a type of brain hemorrhage in which the CT scan will show a white concave/crescent shape; may have the appearance of a moon 40% ✔✔When this percentage of the myocardium becomes damaged, cardiogenic shock is almost inevitable. 60 - 65 mmHg ✔✔the goal MAP (mean arterial pressure) in critical patients in order to provide adequate perfusion to the kidneys Respiratory Opposite, Metabolic Equal ✔✔Acronym ROME, used to determine the source of blood pH changes specificity ✔✔the probability that a test will be negative in the absence of a disease; a measure of how well a test detects a disease without yielding a false positive result sensitivity ✔✔the probability that a test will be positive in the presence of a disease; the degree to which a test detects a disease without yielding a false-negative result isovolumetric contraction ✔✔the stage of the cardiac cycle in which contraction increases pressure in the ventricle, but volume does not change (because the AV valves are closed and the semilunar valves have not opened yet) acid base buffer system ✔✔the first line of defense in regulating pH in the body; converts acid to hydrogen and bicarbonate; takes seconds for this system to recognize a change in pH and react; acts like a micro sponge to soak up excess acids or remain inactive to allow acids to build in an alkaline environment; is easily overwhelmed excretion; reabsorption ✔✔the two processes by which the kidneys alter pH; takes several days to complete

respiratory acidosis ✔✔condition caused by a reduction in alveolar ventilation relative to the rate of CO2 production; essentially is caused by hypercapnia (usually a result of hyperventilation or V/Q mismatch); associated with PaCO2 values over 45 mmHg;caused by central nervous system depression, neuromuscular disease, trauma, severe restrictive disease, abnormal lungs, acute airway obstruction, massive pulmonary edema, massive pulmonary embolism, or severe diffuse airway obstruction; when uncompensated, characterized by decrease in pH, increase in PaCO2, and no change in HCO3; respiratory alkalosis ✔✔condition caused by hyperventilation; causes a decrease in the concentration of potassium and ionized calcium; buffering occurs by cells releasing hydrogen from the body buffers, leading to a reduction in bicarbonate by converting it to CO2; associated with PaCO2 values less than 35 mmHg; caused by anxiety, head trauma, cerebral tumors or CVA affecting the brain stem, fever, pain, pregnancy, pulmonary embolism, pneumonia, altitude, asthma, vagal nerve stimulation, pulmonary vascular resistance, hepatic failure, or mechanical or voluntary hyperventilation; when uncompensated, characterized by increase in pH, decrease in PaCO2, and no change in HCO metabolic acidosis ✔✔condition defined as a reduction of bicarbonate below normal; decreased perfusion results in tissue hypoxia and anaerobic metabolism; may or may not have an increased ion gap; may be caused by acid loss for any reason; when uncompensated,characterized by decrease in pH, no change in PaCO2, and decrease in HCO anion gap ✔✔the "distance" between cations and anions; should be 8 - 16 mEq/L metabolic alkalosis ✔✔condition defined as an elevation of bicarbonate above normal value; results from an elevation of serum bicarbonate or loss of hydrogen ions; pH is primary raised via an increase in plasma HCO3; caused by renal issues, gastrointestinal issues, drugs, sodium bicarbonate administration, or metabolic conversion of citrate, acetate, or lactate; when uncompensated, characterized by an increase in pH, no change in PaCO2, and an increase in HCO pH ✔✔the value that measures the hydrogen ion concentration (acidity) of the blood; normal value is 7.35 - 7. 7.35 - 7.45 ✔✔normal range of the pH of the blood PaCO2 (partial pressure of carbon dioxide) ✔✔the value that measures the amount carbon dioxide dissolved in the blood; considered the most useful measurement value because it directly reflects the adequacy of alveolar ventilation; normal value is 35 - 45 mmHg

35 - 45 mmHg ✔✔normal range of PaCO2 (partial pressure of carbon dioxide) in the blood HCO3 (serum bicarbonate) ✔✔value that measures the bicarbonate ion concentration in the blood; normal value is 22 - 26 mEq/L 22 - 26 mEq/L ✔✔normal range of HCO3 (serum bicarbonate) in the blood BE (base excess) ✔✔value used for the assessment of the metabolic component of acid-base disorders; indicates whether a patient has metabolic acidosis or metabolic alkalosis; the amount of base required to titrate the pH of one liter of blood to normal pH; estimates global tissue acidosis; identifies shock early; predicts transfusion requirements; can assist with predicting complications and mortality of shock; normal value is - 3 to +3 mmol/L

  • 3 - +3 mmol/L ✔✔normal range of BE (base excess) in the blood negative ✔✔Does positive or negative BE (base excess) indicate that the patient has metabolic acidosis? positive ✔✔Does positive or negative BE (base excess) indicate that the patient has metabolic alkalosis?
  • 3 - - 5 mmol/L ✔✔BE (base excess) that indicates mild shock
  • 6 - - 9 mmol/L ✔✔BE (base excess) that indicates moderate shock
  • 10 mmol/L ✔✔BE (base excess) that indicates severe shock PaO2 (partial pressure of oxygen) ✔✔value that measures the amount of oxygen dissolved in the blood; normal value is 80 - 100 mmHg

80 - 100 mmHg ✔✔normal range of PaO2 (partial pressure of oxygen) SaO2 (oxygen saturation) ✔✔value that measures the bound hemoglobin saturation from an arterial blood sample; an estimate of this value can also be measured with a CO-oximeter (rainbow cable); normal value is 90 - 100% 90 - 100% ✔✔normal range of SaO2 (oxygen saturation) SpO2 (peripheral capillary oxygen saturation) ✔✔value that measures the saturation of hemoglobin by using a pulse-oximeter; normal value is 90 - 100%

80 - 100 mmHg ✔✔If SpO2 is 95 - 100%, what should the corresponding PaO2 be, if the oxyhemoglobin dissociation curve is normal? 60 mmHg ✔✔If SpO2 is 90%, what should the corresponding PaO2 be, if the oxyhemoglobin dissociation curve is normal? 40 mmHg ✔✔If SpO2 is 75%, what should the corresponding PaO2 be, if the oxyhemoglobin dissociation curve is normal? 0.08 ✔✔The first "golden rule" of ABG analysis states that for every 10 mmHg change in PCO2, the pH will change by what amount in the opposite direction? 0.15 ✔✔The second "golden rule" of ABG analysis states that for every 10 mEq change in serum bicarbonate, the pH will change by what amount in the same direction? Kg / 4 x BE (base deficit) = mEq bicarbonate needed ✔✔The third and final "golden rule" of ABG analysis states the formula for calculating bicarbonate replacement. What is the formula? (The patient should receive the first half of sodium bicarbonate in a bolus and the second half in a drip over one hour.) 0.6 ✔✔The "forgotten rule" of ABG analysis stated that for every 0.1 change in pH, the potassium will change by what amount in the opposite direction? (This is relevant for high anion gap metabolic acidosis.) 110 - 140 ✔✔normal range of a room air ABG; can be calculated by adding the PaO and the PaCO2 together CBC (complete blood count) ✔✔blood test used as a broad screening test to check for a variety of conditions including anemia and infections; consists of a white blood cell count, white blood cell differential, red blood cell count, hemoglobin and hematocrit, and platelet count 4.5 - 10 (thousand) ✔✔normal range of WBC (white blood cell) count; evaluated in a CBC (complete blood count) neutrophils ✔✔type of WBC (white blood cell); main function is to locate, ingest, and kill bacteria and other foreign invaders; comprise 40 - 70% of WBC's; matures more quickly under stressful conditions; primary defense for bacterial infections; present in band and segmented forms eosinophils ✔✔type of WBC (white blood cell); functions as phagocytes but less potent than neutrophils; can increase in number due to stress, trauma, or catecholamine dump; spend little time in the blood, and migrates to the skin, GI tract or respiratory tract; less than 1% of mature cells are located in the blood

basophils ✔✔type of WBC (white blood cell); constitutes less than 1% of the total WBC count; can increase or decrease with certain diseases monocytes ✔✔type of WBC (white blood cell); primary role is phagocytosis; responsible for ingesting cellular debris; become active upon coming in direct contact with microorganisms; activated cell has greater motility, enzyme activity, and killing capacity; causes pyrogenesis lymphocytes ✔✔type of WBC (white blood cell); main function is antigen recognition and immune response; life span varies but can be as long as two years; can pass back and forth between blood and tissues; can mature into B and T type cells B lymphocytes ✔✔type of lymphocytes (white blood cells) that are produced in the bone marrow and mature there; most effective against bacteria and bacterial toxins as well as some viruses T lymphocytes ✔✔type of lymphocytes (white blood cells) that are produced in the bone marrow but mature in the thymus; recognize and destroy body cells that are malfunctioning including virus-infected cells and cancer cells; consists of helper cells and suppressor cells 3.5 - 6 (million) ✔✔normal range of RBC's (red blood cells); evaluated in a CBC (complete blood count) Hg (Hgb) (hemoglobin) ✔✔the value that measures the globular oxygen carrying protein; evaluated in a CBC (complete blood count); normal value is 15 g/dL (average) 15 g/dL (male: 14 - 18; female: 12 - 16; pediatric: 11 - 16; neonate: 10.7 - 17.1) ✔✔normal Hg (hemoglobin); evaluated in a CBC (complete blood count) Hit (hematocrit) ✔✔the value that measures the volume of RBC's (red blood cells) found in 100 mL of blood, expressed as a percentage; normal value is 45% (average) 45% (male: 40 - 54%; female: 36 - 46%; pediatric: 32 - 45%; neonate: 33 - 55%) ✔✔normal Hct (hematocrit); evaluated in a CBC (complete blood count) 150 - 400 (thousand) mm^3 ✔✔normal platelet count; evaluated in a CBC (complete blood count) MCV (mean corpuscular volume) ✔✔the volume occupied by a single red blood cell; measures the size of the RBC; normal value in males is 78 - 100; normal value in female is 78 - 102

serum osmolality ✔✔the value that measures the amount of chemicals that are dissolved in the serum of the blood; can determine if dehydration or over hydration is present; determines if the hypothalamus is producing enough ADH (antidiuretic hormone); assists in determining the cause of seizures or coma; can assist in determining if the patient has ingested certain poisons and an amount; normal value is 282 - 295 mOsm; critical values are less than 240 or greater than 321 mOsm 282 - 295 mOsm ✔✔normal serum osmolality range < 240 mOsm ✔✔critical low value of serum osmolality

321 mOsm ✔✔critical high value of serum osmolality

PT (prothrombin time) ✔✔the values that measures the effectiveness of Coumadin-type anticoagulants medications; extrinsic pathway; normal value is 11.2 - 13.2 seconds 11.2 - 13.2 seconds ✔✔normal PT (prothrombin time) range INR (international normalized ratio) ✔✔compares PT (prothrombin time) to standardized control; normal value is 1; normal value in patients receiving warfarin therapy is 2 - 3 1 ✔✔normal INR (international normalized ratio) 2 - 3 ✔✔normal INR (international normalized ratio) in patients receiving warfarin therapy PTT (partial thromboplastin time) ✔✔value that measures effectiveness of clotting factors, heparin efficacy, also detects platelet variations; normal value is 22.1 - 34.1 seconds 22.1 - 34.1 seconds ✔✔normal PTT (partial thromboplastin time) range D-dimer ✔✔value that measures degradation products of cross-linked fibrin created during fibrinolysis; "normal" value is less than 0.5 - 1 mcg/mL, but there is no actual normal value as these may vary based on the test manufacturer BUN (blood urea nitrogen) ✔✔blood test that evaluates renal function and hydration status; a metabolic byproduct created from the breakdown of blood, muscle, and protein; normal; normal value is 7 - 21 mg/dL 7 - 21 mg/dL ✔✔normal BUN (blood urea nitrogen) range

Cr (Creatinine) ✔✔blood test that aids in the diagnosis of renal dysfunction; a waste product of protein metabolism found in urine; normal value for a male is 0.6 - 1.4 mg/dL; normal value for a female is 0.6 - 1.2 mg/dL 0.6 - 1.4 mg/dL (0.6 - 1.1 mg/dL for females) ✔✔normal Cr (Creatinine) range BUN/Cr ratio ✔✔blood test that evaluates renal function; normal values are 10:1 or less; elevation of this ratio indicates renal failure 10:1 ✔✔normal BUN/Cr ratio uric acid ✔✔blood test that evaluates renal and urinary traction function; a crystalline product when the body breaks down purines; normal values are 2 - 8 mg/dL 2 - 8 mg/dL ✔✔normal uric acid range BMP (basic metabolic profile) ✔✔blood test that includes sodium, potassium, calcium, and glucose Na+ (sodium) ✔✔aids in maintaining the fluid-electrolyte balance and the acid-base balance; measured in milliequivalents per liter of blood; assessed in a BMP (basic metabolic profile); normal value is 135 - 145 mEq/L 135 - 145 mEq/L ✔✔normal sodium level in the blood K+ (potassium) ✔✔aids in the renal function and acid-base balance; also aids in detecting the origin of arrythmias; most abundant intracellular cation; prevents action potential from being too short; allows for organized fast heart rates; protects excitability; maintains cellular membrane potential; maintains homeostasis of cell volume; slows the heart rate in vagal conditions; measured in milliequivalents per liter of blood; assessed in a BMP (basic metabolic profile); normal value is 3.5 - 5 mEq/L 3.5 - 5 mEq/L ✔✔normal potassium level in the blood Ca+ (calcium) ✔✔aids in neurotransmission, muscle contraction, and proper heart function; most abundant mineral in the body; directly responsible for cardiac muscle contraction and cardiac contractility; determines heart rate; works inversely with magnesium; assessed in a BMP (basic metabolic profile); normal value is 9 - 11 mg/dL 9 - 11 mg/dL ✔✔normal calcium level in the blood 1.5 - 2.5 mEq/L ✔✔normal magnesium level in the blood

CPK (creatine phosphokinase) ✔✔cardiac biomarker; an isoenzyme in skeletal muscles, brain, and cardiac muscles; levels are increased in 90% of myocardial infarctions; can also be indicative of muscle trauma, physical exertion, post-operative, convulsions, delirium tremens; rises within 4 - 6 hours of AMI and peaks at 24 hours; returns to normal in 3 - 4 days in patients with normal renal function; normal value is 5 - 35 mcg/mL 5 - 35 mcg/mL ✔✔normal CPK (creatine phosphokinase) range; cardiac biomarker cTnI (cardiac-specific troponin I) ✔✔cardiac biomarker; contractile proteins of the myofibril; more specific for myocardial injury than CPK-MB; elevated within 2 - 6 hours of cardiac injury onset, peaks within 12 - 16 hours, and remains elevated for 5 - 10 days post infarction, or longer in patients with renal failure; needs to be assessed serially; normal value is less than 0.5 ng/mL myoglobin ✔✔cardiac biomarker; released into circulation after any muscle injury, including cardiac muscle; increased 2 - 6 hours post infarction, peaks in 8 - 12 hours, and returns to normal in 50% of patients within 12 - 36 hours; normal value is 9 - 12 mcg/mL 9 - 12 mcg/mL ✔✔normal myoglobin range; cardiac biomarker BNP (B-type natriuretic peptide) ✔✔cardiac biomarker; a hormone produced by cardiac ventricles when they are stretcher; < 100 pg/mL indicates low likelihood of heart failure, 100 - 400 pg/mL is indeterminate of heart failure; > 400 pg/mL indicates high likelihood of heart failure syncytium ✔✔group of cardiac muscle cells that are connected together and function collectively as a unit absolute refractory period ✔✔the period in which a cardiac cell is unable to respond to any new electrical stimulus and cannot spontaneously depolarize relative refractory period ✔✔the period in which repolarization is almost complete and the cardiac cell can be stimulated to contract prematurely if the stimulus is stronger than normal; "R on T" can occur axis ✔✔the direction of the heart's electrical current from positive to negative vector ✔✔a mark or symbol that can be used to describe any force having both magnitude and direction, such as in lead axis; arrows are most frequently used to display the direction of the electrical flow mean QRS axis ✔✔the average of all ventricular vectors

normal axis ✔✔ECG lead axis that is 0 to 90 degrees physiologic left axis deviation ✔✔ECG lead axis that is 0 to - 40 degrees pathological left axis deviation ✔✔ECG lead axis that is - 40 to - 90 degrees right axis deviation ✔✔ECG lead axis that is 90 to 180 degrees extreme right axis deviation ✔✔ECG lead axis that is - 90 to 180 degrees Mg+ (magnesium) ✔✔mineral necessary for the movement of sodium, potassium, and calcium into and out of cells; if low, must be corrected before attempting to correct potassium deficiencies; normal value is 1.5 - 2.5 mEq/L Starling's Law ✔✔law that states the more the myocardium is stretched the more forceful it will contract diastole ✔✔Any quantitative hemodynamic measurements are taken at the end of this stage of the cardiac cycle. SV (stroke volume) = EDP (end diastolic pressure) - ESP (end systolic pressure) ✔✔formula to calculate SV (stroke volume) ejection fraction (EF) ✔✔the amount of blood pumped out of the left ventricle during each cycle; represented in a percentage of the total blood within the left ventricle; normal is 55% - 75% 55% - 75% ✔✔normal ejection fraction value range 40% - 50% ✔✔ejection fraction value range that indicates damage to the myocardium < 40% ✔✔ejection fraction value range that indicates heart failure EF (ejection fraction) = [SV (stroke volume) / EDV (end diastolic volume)] x 100% ✔✔formula to calculate EF (ejection fraction) CO (cardiac output) = SV (stroke volume) x HR (heart rate) ✔✔formula to calculate CO (cardiac output) CI (cardiac index) = (SV [stroke volume] x HR [heart rate]) / BSA (body surface area) ✔✔formula to calculate CI (cardiac index)