Critical Care Paramedic Exam 2023
Critical Care Paramedic Exam 2023
Normal pH
7.35-7.45
Normal CO2
35-45
Normal HCO3
22-26 (good dating
... [Show More] age)
Normal PaO2
80-100
Normal SaO2
> 95%
Base (deficit/excess)
(-2) - (+2)
Buffer systems: Bicarb reaction time
seconds
Buffer systems: Lungs reaction time
minutes
Buffer systems: Kidneys reaction time
hours to days
Minute volume calculation
Tidal volume x respiratory rate
pCO2 >45
acidotic
pCO2 <35
alkalotic
HCO3 <22
acidotic
HCO3 >26
alkalotic
base deficit of < -4
indicator for the potential need for blood transfusion
base deficit of < -19
indicates poor outcome (death likely)
base deficit replacement formula
0.1 x (-BE) x patient weight in kg = bicarb needed
PO2 of 60 is roughly equivalent to a SaO2 of
90%
critical pH for intubation
< 7.2
critical pCO2 for intubation
> 55
critical pO2 for intubation
< 60
number one cause of metabolic acidosis
lactic acidosis (lactate > 4)
CO2 is a byproduct of
metabolism
for every __ change in ETCO2, you should expect the pH to change __ in the
___________ direction.
10, 0.08, opposite
for every __ change in pH, you should expect the HCO3 to change __ in the
___________ direction.
0.15, 10, same
for every __ change in pH, you should expect the potassium to change __ in the
___________ direction.
0.10, 0.6, opposite
LEMON
difficult intubation
look, evaluate (3-3-2), mallampati, obstructions, neck mobility
HEAVEN
difficult intubation
Hypoxia, extremes of size, anatomic challenges, vomit/blood/fluid,
exsanguination, neck mobility issues
ramping
ear to sternal notch
without ramping during intubation or transport causes a potential for
decrease in functional reserve capacity, tidal volume, and preload
Sellick's maneuver and BURP
no longer recommended
External laryngeal manipulation (ELM)
current standard of practice
bougie adult size
15 Fr
bougie pediatric size
10 Fr
bougie neonatal size
6 Fr
supraglottic devices
provide little protection against aspiration
ETT cuff pressure
20-30 mmHg (25 is standard)
gold standard of confirming ET placement
chest X-Ray
distal tip of ET
2-3 cm (1 inch) above carina, at T3 or T4
7 p's for RSI success
preparation, preoxygenation, pretreatment, paralysis with induction,
protect/position, placement (with proof), post intubation management
LOAD
pretreatment for RSI
lidocaine, opiates, atropine (infants), defasiculating dose
fentanyl adult dose
1 mcg/kg
fentanyl onset
3-5 mins
fentanyl post intubation management
0.5 - 1.5 mcg/kg every 5 minutes
fentanyl post intubation management infusion
1-3 mcg/kg/hour
fentanyl reversal agent
narcan
etomidate adult dose
0.3 mg/kg
etomidate onset time
15-45 seconds
etomidate duration
3-12 minutes
etomidate cautions/contraindications
hemodynamically unstable patients, adrenal suppression, shock patients,
COPD/asthmatic
ketamine adult dose
1-2 mg/kg
ketamine onset
40-60 seconds
ketamine duration
10-20 minutes
ketamine is preferred for
asthmatic patients
ketamine post intubation management
0.5 - 1 mg/kg
ketamine post intubation management infusion
1-2 mg/kg/hour
versed adult dose
2.5-5 mg
versed onset
30-60 seconds
versed duration
15-30 minute duration
versed post intubation management
2-5 mg
versed post intubation management infusion
0.05 - 0.1 mg/kg/hour
versed reversal agent
flumazenil (romazicon) 0.2 mg
propofol (diprivan) adult RSI dose
1-2 mg/kg
propofol (diprivan) adult maintenance dose [Show Less]