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Pulmonary Hypertension and Cardiac Arrest Management, Exams of Nursing

Comprehensive information on normal mean pulmonary artery pressure, pulmonary hypertension, its causes, and management strategies. It also covers various cardiac arrest scenarios, including stemi, heart block types, and defibrillation and cardioversion doses. The document also includes guidelines for managing anaphylaxis, lower airway obstruction, and acute asthma.

Typology: Exams

2023/2024

Available from 06/03/2024

NurseMaryK
NurseMaryK 🇬🇧

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Air Methods Critical Care Exam Questions and
Answers Graded A+
1.What is the most reliable method of confirming and
monitoring correct placement of an ET tube? –ANSWER-
Continuous waveform capnography
2.The upper airway consists of...: –ANSWER-Nose, Mouth, Jaw,
Oral Cavity, Pharynx, and Larynx
3.No gas exchange occurs here , it's called .: –
ANSWER- Nose to terminal bronchioles, anatomical dead space.
(2ml/kg of inspired tidal volume) They conduct airflow towards gas
exchange units.
4.Crycothyroid membrane: –ANSWER-between thyroid and cricoid,
avascular structure that connects the thyroid and cricoid cartilage. Site
of CRiCOTHYROTOMY- an emer- gency opening of the airway.
5. A PaCO2 greater than 45 mmHg indicates:
A. Metabolic acidosis.
B. Metabolic alkalosis.
C. Respiratory acidosis.
D. Respiratory alkalosis.: –ANSWER-C. Respiratory acidosis
6.PaCO2 normal range: –ANSWER-35-45 mm Hg Less than 35 likely
means hyperventilation
7.Tracheal deviation AWAY from the affected side, decreased
breath sounds, and hyperresonance... What's happening?: –
ANSWER-Tension pneumothorax
8. In a tension pneumothorax tracheal deviation goes in what
direction?: -
AWAY from affected side.
9.Normal mean pulmonary artery pressure: –ANSWER-10-20 mmHg
10.Pulmonary hypertension is a mean PA pressure greater
than...: –ANSWER- (PAm) greater than 20
11.Primary pulmonary hypertension–ANSWER-: Idiopathic genetic
disorder caused by ab- normal structure of the pulmonary blood
vessels
12.Name three causes of secondary pulmonary hypertension..: –
ANSWER-1. Passive PH- the result of back pressure. Mitral Stenosis, LV
systolic failure.
2.Active PH- Constriction of the pulmonary circuit Increased volume in
pulmonary circuit (i.e. congenital heart disease)
3.Obstruction as in Chronic recurrent PE
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Air Methods Critical Care Exam Questions and

Answers Graded A+

  1. What is the most reliable method of confirming and monitoring correct placement of an ET tube? –ANSWER- Continuous waveform capnography
  2. The upper airway consists of...: –ANSWER- Nose, Mouth, Jaw, Oral Cavity, Pharynx, and Larynx
  3. No gas exchange occurs here , it's called .: – ANSWER- Nose to terminal bronchioles, anatomical dead space. (2ml/kg of inspired tidal volume) They conduct airflow towards gas exchange units.
  4. Crycothyroid membrane: –ANSWER- between thyroid and cricoid, avascular structure that connects the thyroid and cricoid cartilage. Site of CRiCOTHYROTOMY- an emer- gency opening of the airway. 5. A PaCO2 greater than 45 mmHg indicates: A. Metabolic acidosis. B. Metabolic alkalosis. C. Respiratory acidosis. D. Respiratory alkalosis.: –ANSWER- C. Respiratory acidosis
  5. PaCO2 normal range: –ANSWER- 35-45 mm Hg Less than 35 likely means hyperventilation
  6. Tracheal deviation AWAY from the affected side, decreased breath sounds, and hyperresonance... What's happening?: – ANSWER- Tension pneumothorax 8. In a tension pneumothorax tracheal deviation goes in what direction?: - AWAY from affected side.
  7. Normal mean pulmonary artery pressure: –ANSWER- 10-20 mmHg
  8. Pulmonary hypertension is a mean PA pressure greater than...: –ANSWER- (PAm) greater than 20
  9. Primary pulmonary hypertension–ANSWER-: Idiopathic genetic disorder caused by ab- normal structure of the pulmonary blood vessels
  10. Name three causes of secondary pulmonary hypertension..: – ANSWER- 1. Passive PH- the result of back pressure. Mitral Stenosis, LV systolic failure. 2.Active PH- Constriction of the pulmonary circuit Increased volume in pulmonary circuit (i.e. congenital heart disease) 3.Obstruction as in Chronic recurrent PE
  1. TNP of the Pregnant patient: –ANSWER- Resuscitation priorities are the same. The best way to take care of the baby is to take care of mama
  2. Mechanisms of injury and biomechanics the most common cause of ma- ternal injury is...: –ANSWER- Blunt trauma caused by MVC. Second is BT caused by falls, 3rd is violence
  3. fetal distress is an early sign of maternal distress... Why?: – ANSWER- Catecholamine mediated vasoconstriction resulting from blood loss shunts blood away from the fetus to the mom.

This lab is used to determine if hemorrhage of fetal blood through the placenta and into maternal circulation. KB test is an important detector of abruptio placentae, preterm labor and need to administer Rh negative globulin when mom is Rh negative and fetus is Rh positive.

  1. Continue fetal monitoring for a minimum of ---- hours for any viable preg- nancy and up tohours if there is abdominal trauma:
  2. 24
  1. Sonography has for diagnosis placental abruption,: – ANSWER- POOR.... they miss 50-80% of abruptions.
  2. In addition to routine labs a: –ANSWER- Prothrombin (PT ) and PTT and serial coags should be drawn. Beta Human Chorionic gonadotropin (BHCG)
  3. Measure and record fundal height every: –ANSWER- 30 minutes.
  4. Pediatric Mechanisms of injury and biomechanics: Blunt trauma MVC > suffocations > drownings > fires/burns. No. 1 cause of fatalities is TBI.
  5. Primary Survey/ Resuscitation: –ANSWER- Survival rates in pediatric emergency can be directly correlated with
  6. RAPID AIRWAY MANAGEMENT,
  7. INITIATION OF VENTILATORY SUPPORT, AND
  8. EARLY RECOGNITION OF AND EARLY RESPONSE TO INTRA abdominal AND intracranial hemorrhages
  9. A STEMI is a resulting from a .: –ANSWER- Complete Occlusion of a coronary artery caused by a ruptured Plaque leading to blood clot formation in the coronary.
  10. STEMI diagnosis: Chest pain + positive cardiac enzyme (TROP.

0.4), and --ST segment ELEVATIONS greater than 1 mm in two or more contagious leads V1-V -Reciprocal (depressions) changes in leads II, III, AVF 39. STEMI EKG findings: STEMI 40. STEMI EKG findings more: -St elevations > 1mm in Limb leads: 1, II, III, avF, avL -St elevations > 2mm in precordial leads (v1- v6) AND/OR -NEW LBBB Contiguous leads with reciprocal changes in opposite leads

  1. First degree Heart Block EKG: AV block Prolonged PR Interval greater than 120-200 ms
  1. Second Degree Heart Block (Mobitz II): = Damage AT av node - moderate
  • PR-interval is normal; QRS complexes are dropped erratically
  • ALL must have a pacemaker in the next 72 hrs.
  1. STEMI Nitro gtt: 5-10 mcg per minute Titrate by 10 mcg max dose 300 mcg per minute
  2. How do you mix epi?: Mix 1 mg in 1 L NS or D5W or LR for a concentration of 1 mcg/ ml
  3. What's the epi dose for hypotension s/p arrest?: 0.1 - 0. mcg/kg/min **48. What is the epi dose for anaphylaxis?:
  4. Pediatric Epinephrine dose:**
  5. PALS 2020 update: AHA 2020 BASIC BP Diastolic BP of at least 25mmhg in infants and at least 35 mmhm in children correlates with better outcomes.
  6. PALS Brady with a pulse: Assess airway, breathing, mental status Most common cause is hypoxia! could also be hypothermia and or medications. s/s of shock? AMS? hypotensive? Start CPR if any of these Always start CPR if HR < 60 bpm iv access Give Epi 0.01 mg/kg (0.1ml of 0.1mg/ml solution) Repeat Q 3-5 minutes
  7. Initial management of pediatric respiratory distress or Failure A: 1. A-ABC. Support open airway: Comfort or Head tilt chin lift. Jaw thrust. Clear airway if indicated. (suction nose or mouth if indicated) Consider OPA or NPA. IDENTIFY type and Severity of respiratory problems
  8. Initial management of pediatric respiratory distress or Failure B: 2. B-Mon- itor Spo2 withPulse ox. Provide high concentration O2, via non rebreather -Administer inhaled meds: Albuterol or Epi. as needed -Assist ventilation with child ambu + o2 if needed. Prepare for intubation if needed.
  1. Initial management of pediatric respiratory distress or Failure C: 3.C-Mon- itor heart rate, rhythm and BP. Establish IV/IO access. and fluids/ meds as needed. Evaluate Identify Intervene
  2. What is an upper airway obstruction?: Interruption in airflow through nose, mouth, pharynx, or larynx. The large always outside the thorax.

-Give continuous nebulizer treatment if needed. -**For severe respiratory distress anticipate further airway swelling and prepare for endotracheal intubation

  1. PALS Management of anaphylaxis continues: To treat hypotension: -Place child in trendelenburg position as tollerated

-administer isotonic crystalloid (NS/LR) at 20ml/kg repeat as needed. -For hypotension unresponsive to fluids and IM epinephrine, start a gtt at 0.05-2 mcg/kg/min titrate to effect

  1. Pals Management of anaphylaxis continues finally...: Administer Diphenhy- dramine 1mg/kg and an H2 blocker, ranitadine IV. -Administer methylprednisolone or equivalent IV
  2. PALS Management of Lower Airway Obstruction: After ABC... If assisted ventilation is needed provide at a slow rate.
  3. PALS Management of Lower Airway Obstruction Bronchiolitis: After ABC -Suction as needed Consider labs: viral studies, chest X-ray and ABG trial nebulize epi or albuterol, if no improvement, Discontinue
  4. PALS Management of acute asthma Mild to Moderate: - Administer humidified O2 in high concentration via nasal cannnula or O mask. K -Keep SpO2 >= 94% -Administer Albuterol via MDI or Nebulizer -PO corticosteroids
  5. PALS Management of Moderate to Severe Asthma: - Administer O2 for a SpO2 >= 94% NC or NRB -Albuterol via MDI with Spacer or Nebulizer -Continuous Albuterol may be needed -Administer Ipatroprium in combo with the albuterol -Corticosterorids IV -Magnesium Sulfate 25-50mg/Kg via slow IV bolus over 15 to 30 minutes. MAX 2g -Labs as indicated
  6. PALS Management of Severe Asthma: In Addition to all of the interventions for moderate to sever asthma... -Consider Terbutaline 10mcg/Kg load over 5 minutes SQ or as a gtt 0. mcg/kg/min or IM epi as an alt.
  • Bipap -If refractory hypoxemia intubate.
  1. Epi Dose, Flight nurse trick: 0.1ML/kg no matter what concentration according to Bill.
  2. PALS Defibrillation dose: 2 J/kg
  3. PALS Cardioversion dose: 0.5-1 J/KG

-Irregular Breathing

  • Hypertension
  • Tachycardia In adults it's bradycardia Hyperventilate the patient to prevent further increases in ICP -hypertonic saline, Osmotic agents (dose?) -Treat pain and agitation aggressively once airway is established. -Avoid hyperthermia
  1. PALS management of respiratory distress due to poisoning: -Support air- way -give antidote -call poison control
  2. Ventilation Management: a Tidal volume is 5-7mL/Kg aprox. 500ml for an adult
  1. hemodynamic changes in Cardiogenic shock: SBP (Down) SVR (UP) CVP (UP) CO (Down) PAP (UP) Wedge (UP) PVR (UP)
  2. Coags (PT/INR/PTT): PT 11-14s PTT (20-40 sec) heparin INR (0.9-1.2) Coumadin Platelets : 150-450k
  3. Blood Gas: pH: 7.35-7. PaCO2: 35- 45 PaO2: 80- 100 HCO3: 22- 26
  4. chemistry panels (renal, hepatic, comprehensive, metabolic): Na+ 135-145 Cl- 95- K+ 3.5-4. Cr 0.6-1. Glucose 70- 100 Magnesium 1.7-2.
  1. Magnesium: 1.7-2.
  2. K+ (potassium): 3.5-5.0 mEq/L
  3. Na+: 135-145 mEq/L
  4. Glucose: 70-110 mg/dL

-PEEP will be used with assist control -ranges from 5-15cm of H

Good for sedated patients who can't initiate breaths or who have primary pulmonary problem medical management

  1. Spontaneous Intermittent Mandatory Ventilation SIMV: -Has a preset rate /minute ventilation Allows patient to over breathe a set Spontaneous breaths are not supported, so tidal volume varies based on what the patient can pull
  2. Pressure Control Ventilation: Set pressure -Machine is set to deliver a certain pressure over a certain I-time. pressure remains constant Tidal Volume changes as lungs change
  3. Pressure Support Ventilation (PSV): -Used to lower the work of spontaneous breathing and augment a patients spontaneous tidal volume -PSV is often used with SIMV and CPAP, or as a stand alone mode to facilitate weaning -Psv should increase spontaneous Vt, decrease respiratory rate and decrease WOB -PSV decreases work of breathing that is superimposed by the artificial airway
  4. Stroke Volume (SV): The volume of blood pumped forward with each ventric- ular contraction. EDV-ESV= SV 50-100 cc per beat basically Males: 65- Females: 66- 148
  5. RSI drugs paralytics: Rocuronium 1mg/ Kg Onset 1 minute Duration 30 minutes
  6. RSI drugs paralytics Succs: Succs 1mg/kg Onset Duration Contraindications: hyperkalemia 10 days post burn crush Denervation injury MH predisposition
  7. RSI drugs induction k: Ketamine 1-2 mg/kg Bronchodilator
  8. RSI Drugs Induction E: Etomidate 0.3mg/kg
  1. Lead II looks at: The apex of the heart- should be a positive deflection. It's a positive lead that looks at the apex of the heart. P wave: atrial depolarization
  2. Left bundle branch...: Is what actually depolarizes the intraventricular septum
  3. In lead II, depolarization of the septum ( LBB) is what part of the ekg?: The negative deflection known as the Q wave! The Q wave is indicative of intraventricular Septal depolarization
  4. The R the wave is indicative of: Ventricular depolarization
  5. SaO2: 95-100% percent of hemoglobin that is saturated with oxygen.
  6. Adult Acls Dopamine infusion dose: 2-10 mcg/ kg / min
  7. Adult ACLS Epi infusion dose: 2-10 mcg/kg/min
  8. Adult ACLS Bradycardia Atropine dose: 1st dose: 0.5 mg bolus Repeat q 3-5 minutes Max dose 3mg 114. Adult ACLS Cardiac Arrest Amio dose: 1st: 300mg bolus 2nd: 150mg:
  9. Adult ACLS how many compressions?: At least 100 compressions a minute
  10. Vasopressin push dose & infusion dose: 1 dose of 40 units 0.02-0.04 units per minute
  11. Thrombocytopenia: Platelet count of less than < 150,000 uL
  12. Trauma triad of death: -Hypothermia: warm room, warm blanket, warmed fluid
  • Coagulapathy -Metabolic acidosis
  1. DIC Coag Lab values: D-Dimer 1-5 mcg/ml Fibrinogen < 100 mg/dL (Normal 200-400 mg/dL)
  2. Normal PR interval: 0.12-0.20 seconds
  3. Normal QRS duration: 0.04-0.12 seconds
  4. WBC: Normal is 5-10K mm
  5. A normal Q-T interval is .: 0.31-0.41 sec when heart rate is 70 beats/min Has to be corrected for HR
  1. Shockable rhythms: V fib V tach (pulseless)
  2. Junctional Escape Rhythm: a rhythm that occurs when the SA node fails to initiate the electrical activity and one of the backup pacemaker sites takes over Rate 40-60 (61-100 accelerated) No p wave