FPC / CFRN - Review Exam - Version B 2023 with verified questions and answers

Myxedema coma is also known as... A. Thyroid storm B. Adrenal insufficiency C. Hypothyroidism D. Hyperaldosteronism Hypothyroidism Most common presentation of a patient with hypothyroidism are all of the following, Except... A. Cold intolerance with coarse hair B. Almost exclusively over the age of sixty C. 90% of cases occur in the winter D. Primarily in men Primarily in men Hypothroidism occurs primarily in women, almost exclusively over the age of sixty, with 90% of the cases occurring in the winter months. Your patient presents with following parameters: CVP 0, CI 1, PA S/D 8/4, wedge 3, and SVR 1,800. What is your diagnosis? A. Hypovolemic shock B. Right ventricular infarction C. CHF D. Sepsis Hypovolemic shock Careful interpretation of the CVP is important! Central venous pressure (CVP) describes the pressure of blood in the thoracic vena cava, near the right atrium of the heart. CVP reflects the amount of blood returning to the heart and the ability of the heart to pump the blood into the arterial system. Drug of choice for profound hypotension in septic shock is? A. Isotonic crystalloid solution B. Levophed C. Nipride D. Dobutamine Levophed Sepsis is by far the most common cause of distributive shock. The average normal ICP range is... A. 0-10 mmHg B. 10-20 mmHg C. 20-30 mmHg D. 30 mmHg Normal ICP range is 0-10 mmHg, but range can go as high as 15 mmHg. The formula to calculate MAP is A. 2/3 DBP × SBP B. 2 × DBP + SBP divided by 3 C. 2 × SBP + DBP D. 2 + DBP × SBP divided by 3 2 × DBP + SBP / 3 (normal 80-100 mmHg) Normal coronary perfusion pressure (CPP) is A. 50-60 mmHg B. 70-90 mmHg C. 80-100 mmHg D. 50 mmHg Normal 50-60 mmHg Coronary perfusion pressure: (CPP) = DBP-PAWP The patient presents with the following hemodynamic parameters: CVP 1, CI 1.7, PA S/D 12/6, wedge 6, and SVR 300. Vital signs are 78/40, HR 60, RR 16, SaO2 98%. The most likely cause is... A. RVMI B. Neurogenic shock C. Septic shock D. Hypovolemic shock Neurogenic shock SVR 800, think distributive shock. Next look at the CI; is it less than 2.5? Hypotension and either a normal heart and/or bradycardia present narrows the type of distributive shock as being neurogenic shock. Severe hypothermic Pt's are at highest risk for which of the following rhythm? A. A-Fib B. Asystole C. V-Fib D. Sinus Brady V-Fib Severe: 20-28 (coma, VF common) The drug of choice for a patient exhibiting signs and symptoms of malignant hyperthermia is: A. Anectine B. Sodium bicarbonate C. Dantrolene D. Glucagon Dantrolene Malignant hyperthermia: Characteristic signs are muscular rigidity, followed by a hypercatabolic state; with increased oxygen consumption, increased carbon dioxide production (hypercapnea, usually measured by capnography), tachycardia (fast heart rate), and an increase in body temperature (hyperthermia) at a rate of up to ~2°C per hour, temperatures up to 42°C (108°F) are not uncommon. Induction agent of choice with bronchospastic patients Ketamine (ketalar) Ativan: indication dose, max Lorazepam, seizures, 1-2 mg, max 4 mg Mannitol dose 1-2 g/kg Mannitol: an osmotic diuretic, acts by osmosis to ensure urine production and may prevent heme deposition in the kidney. Can be administered to avoid acute renal failure when fluid administration has been ineffective. Drug choice for cyclic antidepressant OD Sodium bicarbonate Drug choice for beta-blocker OD Glucagon Fentanyl dose Sublimaze (3 μg/kg) Treatment for malignant hyperthermia Dantrium (dantrolene) Drug for GI bleeds Sandostatin (octreotide) You have been requested to transport a twenty-year-old female from an ICU with a history of TCA overdose two hours prior to your arrival at the sending facility. Your cardiovascular assessment of the patient would most likely include all of the following with this type of toxicity, EXCEPT... A. Early sinus bradycardia B. Widening QRS C. Prolonged QT and PR interval D. Early tachycardia Early sinus bradycardia Sinus tachycardia is the most common cardiac disturbance seen following TCA overdose. Rhabdomyolysis treatment - preventing shock and preserving kidney fxn - NS with sodium bicarbonate Your patient presents with ABG's of pH 7.39, pCO2 68 HCO3 32, pO2 82. He has history of COPD and weighs 65 kg. He presents with a history of SOB for 3 days with a RR 20 and is on 4 L/minute of oxygen by NC. He speaks in four- to five-word sentences. What acid-base disorder is present? A. Metabolic acidosis with partial compensation B. Respiratory acidosis with complete compensation C. Metabolic alkalosis with no compensation D. Respiratory alkalosis with no compensation Respiratory acidosis with complete compensation. The pCO2 is elevated, which is the primary disorder, and the compensatory response is the increased HCO3. The pH is normal, so there is complete compensation. Which formula can be used when calculating a cerebral perfusion pressure (CPP)? A. [(DBP × 2) + SBP] divided by 3 B. MAP − ICP C. ICP − DBP D. [(DBP + 2) × SBP] divided by 3 MAP − ICP = CPP Normal range (mmHg): 70-90 You are managing a patient who has been diagnosed with hepatic encephalopathy. His ammonia levels are elevated. Your management in preparing this patient for transport is to inhibit elevated protein level by... A. Administering whole blood B. Stop GI bleeding and evacuate bowel of blood C. Aggressive fluid resuscitation D. Aggressive pain control Stop GI bleeding and evacuate bowel of blood Bowel cleansing is the mainstay of therapy for hepatic encephalopathy. Evacuation of gutderived toxins (intestinal blood, bacteria) and administration of Lactulose (orally or as an enema) is one of the cornerstones of the treatment of hepatic encephalopathy. Lactulose may be given orally to acidify the ammonia in the colon and form the ammonium that can be easily excreted. It is used as a laxative for evacuating blood from intestines and for reducing ammonia production by intestinal bacteria. Gastrointestinal bleeding should also be controlled. Grey Turner's sign may indicate? A. Meningitis B. Splenic injury C. Retroperitoneal bleed D. Gallbladder Retroperitoneal bleed Grey Turner's sign refers to bruising of the flanks and can indicate retroperitoneal or intraabdominal bleeding, which can take up to 24-48 hours to show up on assessment. It can be caused by acute pancreatitis, blunt abdominal trauma, ruptured abdominal aortic aneurysm, or ruptured/hemorrhagic ectopic pregnancy. Most commonly seen injuries with side impact or "lay it down" motorcycle crashes include all of the following, EXCEPT: A. Open fracture of the femur B. Pelvic fractures C. Abrasions to the affected side D. Tibia/fibula or malleolus fractures Pelvic fractures Your patient was struck from behind while driving. The most common area of injury from a rear-end collision is: A. Ankle fracture B. Coup Contrecoup injury pattern C. C2 fracture D. T12-L1 injuries T12-L1 injuries Dry chemicals such as lime should be... A. Brushed off before irrigation B. Neutralized with a special agent before irrigation C. Irrigated immediately with water or physiologic saline D. Wrapped in a dressing and not irrigated Brushed off before irrigation Chemical burns differ from thermal burns in that the burning process continues until the agent is inactivated by reaction of tissues: neutralized or diluted with water. Dry chemicals, such as lime, should be brushed off before irrigation. Water and physiologic saline are fluids of choice for wound irrigation. Hamman's sign may indicate which of the following? A. Tension pneumothorax B. Tracheobronchial injury C. Aortic rupture D. Cardiac tamponade Tracheobronchial injury Hamman's sign is a crunching sound heard with auscultation and may be synchronized with the patient's heart beat. This sign is associated with tracheobronchial injury. Recommended urinary output when managing a burn patient without an electrical injury is: A. 100 mL/hr B. 10-20 mL/hr C. 30-50 mL/hr D. 100 mL/hr 30-50 mL/hr Hydrofluoric burns can be managed with copious amounts of water and... A. Calcium gluconate B. Osmotic diuretics C. Glucagon D. Pyroxidine Calcium gluconate Hydrofluoric acid exposure is often treated with calcium gluconate, a source of Ca2+ that sequesters the fluoride ions. HF chemical burns can be treated with a water wash and 2.5% calcium gluconate gel or special rinsing solutions. However, because it is absorbed, medical treatment is necessary; rinsing off is not enough and in some cases, amputation may be necessary. The management approach for a patient experiencing brain herniation can include all of the following, EXCEPT: A. Serum sodium goal 155 B. Serum osmolality less than 320 C. Hypertonic saline, mannitol D. Hyperventilation to maintain EtCO2 at 20-30 mmHg Hyperventilation to maintain EtCO2 at 20-30 mmHg Routine hyperventilation is not longer recommended in the initial management of the patient with traumatic brain injury. The patient's EtCO2 should be maintained between 35-45 mmHg. Classic picture of neurogenic shock presents with... A. Hypertension B. Absence of tachycardia C. Cool skin D. Pallor Absence of tachycardia Loss of sympathetic tone below the level of the injury results in loss of autoregulation, a decrease in vascular tone, and inability of the heart to increase its intrinisic rate. The classic picture of neurogenic shock presents with the absence of tachycardia. You are transporting a patient with a spinal cord injury above T6 level. His baseline vital signs prior to lift off: BP 160/80, HR 62, RR 20. During transport, the patient begins to complain of a throbbing headache with nasal stuffiness. Your assessment reveals that the patient is becoming increasingly agitated. His skin color is flushed and profusely diaphoretic. Repeat vital signs are a BP 206/100, HR 52, RR 26. Your initial management of the patient would be... A. Insert a foley catheter B. Administer nitroglycerin to help reduce blood pressure C. Hang a Nipride drip if diastolic is greater than 130 mmHg D. Do nothing because increased HTN is expected with altitude and spinal cord injuries. Insert a foley catheter Autonomic dysreflexia (AD), also known as "autonomic hyperreflexia or hyperreflexia," is a potentially life-threatening condition, which can be considered a medical emergency requiring immediate attention. AD occurs most often in spinal cord-injured individuals with spinal lesions above the T6 spinal cord level. Acute AD is a reaction of the autonomic (involuntary) nervous system to overstimulation. Your patient presents with motor loss, numbness to touch, vibration on the same side of the spinal injury, loss of pain, and temperature sensation on the opposite side. You suspect that the most likely spinal cord syndrome present is: A. Brown-Séquard B. Central cord C. Anterior cord syndrome D. Neurogenic shock Brown-Séquard Any presentation of spinal injury that is an incomplete lesion can be called a partial Brown-Séquard or incomplete Brown-Séquard syndrome, so long as it has characterized by features of a motor loss and numbness to touch and vibration on the same side of the spinal injury and loss of pain and temperature sensation on the opposite side. Most often occurs from a penetrating injury that has damaged one side of the spinal cord. Blood supply to the anterior portion of the spinal cord is interrupted, causing a complete motor paralysis below the level of the lesion due to interruption of the corticospinal tract. Loss of pain and temperature sensation at and below the level of the lesion due to interruption of the spinothalamic tract. Retained proprioception and vibratory sensation due to intact dorsal columns. Most often occurs after hyperflexion injury "Anterior cord" syndrome It is characterized by disproportionately greater motor impairment in upper compared to lower extremities and variable degree of sensory loss below the level of injury. Most often occurs after hyperextension injury. "Central cord" syndrome Sinusoidal patterns are commonly associated with all of the following, EXCEPT: A. Fetal hypovolemia or anemia B. Accidental tap of the umbilical cord during amniocentesis C. Pregnancy-induced hypertension (PIH) D. Placental abruption Pregnancy-induced hypertension A uniform sine wave pattern indicates fetal hypovolemia or anemia and may occur in cases of erythroblastosis fetalis, accidental tap of the umbilical cord during amniocentesis, fetomaternal transfusion, placental abruption, or another type of accident. Diving injuries - 1 ATM for every ??? feet descent 1 ATM for every 33 feet descent You will be transporting a stable twenty-seven-year-old man with nontraumatic pneumocephalous secondary to gas producing necrotizing bacteria from rural hospital at 8,500 feet elevation to a local hospital at 1,200 feet sea level. What might be the best transport option? What gas law will most affect this patient negatively? A. Ground; Boyle's law B. Fixed wing transport pressurized to 9,000 AGL; Charles' law C. Rotor transport; Boyle's law D. Rotor transport; Charles' law Ground; Boyle's law Pneumocephalus is the presence of air or gas within the cranial cavity. It is usually associated with disruption of the skull: after head and facial trauma, tumors of the skull base, after neurosurgery or otorhinolaryngology, and rarely, spontaneously. Pneumocephalus can occur in scuba diving, but is very rare in this context. Unpressurized aircraft is not recommended for this patient's condition. When performing a pericardiocentesis, the insertion site is... A. Below the subxyphoid process B. Just right of the subxyphoid process C. Just left of the subxyphoid process D. Above the subxyphoid process Just left of the subxyphoid process The initial treatment of a patient with a suspected cardiac tamponade is a rapid intravenous fluid bolus. Pericardial blood will generally NOT CLOT because it has been defibrinated by heart motion. ABG reveals pH 7.41, pCO2 38, HCO3 22, pO2 56 of a 70-kg patient on a ventilator with the following settings: Vt 700, F 14, FIO2 0.5, I:E 1:2, PIP 46, Pplat 40, and PEEP 5. How will you manage this patient? A. Increase FIO2 B. Increase PEEP C. Decrease Vt D. All of the above Increase FIO2 The pCO2 is 60 mmHg, indicating hypoxemia. Treatment includes increasing the FIO2. Increasing levels of PEEP in critically ill patients may also provide acceptable oxygenation and can reduce the FIO2 to nontoxic levels (FIO2 0.5). The level of PEEP must be balanced such that excessive intrathoracic pressure does not occur (preventing barotrauma/decreased venous return). When managing pO2 of 60, you would? A. Increase FIO2 and apply/or increase PEEP B. Increase Vt and apply/or increase PEEP C. Increase FIO2 D. Increase Vt Increase FIO2 and apply/or increase PEEP You are transporting a seventy-five-year-old man with a diagnosis of inferior wall MI. During the flight you note V-Tach. Vital signs are: 70/palp, HR 150, RR 24, SpO2 94% on high flow oxygen with NRM at 15 L/min. He is awake and complains of chest pain and SOB. How will you manage this patient? A. Administer lidocaine and nitroglycerin B. Administer normal saline bolus C. Consider sedation and synchronize cardiovert at 100 joules D. Have the patient cough forcefully Consider sedation and synchronize cardiovert at 100 joules. The patient you are transporting reveals the following ABG: pH 7.51, pCO2 28, HCO3 24, pO2 110. He is a 60-kg male patient with Vt 650, F14, FIO2 0.21, I:E 1:2, PIP 46, Pplat 42, and PEEP 0. What is your ABG interpretation, and how will you correct it? A. Respiratory acidosis; increase respiratory rate (F) B. Respiratory alkalosis; decrease Vt C. Metabolic alkalosis; increase FIO2 D. Respiratory alkalosis; increase PEEP Respiratory alkalosis; decrease Vt The pCO2 is decreased and the pH is increased, indicating a respiratory alkalosis. The HCO3 is normal, indicating there is no compensation. Minute ventilation is... A. RR × weight in kg B. RR × SPO2 C. Vt × weight in kg D. Vt × RR Vt × RR Tidal volume times the respiratory rate equal minute ventilation. Minute ventilation is defined as the total volume of air (gas) moved into and out of the lungs each minute. The formula is known as VE = Vt × f. VE signifies minute ventilation; Vt signifies tidal volume and f signifies respiratory rate. Alveolar minute volume is the amount of gas that reaches the alveoli for gas exchange in one minute. The formula is VAmin = (VT-VD) × Respiratory Rate. High-pressure alarms can be caused by all of the following, EXCEPT: A. Hypovolemia B. Connections C. Pneumothorax D. Obstructions Hypovolemia Low-pressure alarms can be caused by all of the following, EXCEPT: A. Hypovolemia B. Leaks in ventilator tubing C. Pneumothorax D. Connections Pneumothorax Pneumothorax can trigger high-pressure alarms when resistance to ventilation is too high. You are managing a four-year-old boy who is requiring intubation. The appropriate size ET tube for this patient would be... A. 3.5 B. 4.0 C. 4.5 D. 5.0 5.0 Using the formula 16 + age in years divided by 4 equals an ET tube size of 5.0. Vt is calculated at: A. 3-5 mL/kg B. 5-8 mL/kg C. 6-10 mL/kg D. 10-15 mL/kg 5-8 mL/kg Vt (tidal volume) of 5-8 mL/kg is generally indicated, with the lowest values recommended in the presence of obstructive airway disease and ARDS. The goal is to adjust the TV so that plateau pressures are less than 35 cm H2O. The test most often used to diagnose a pulmonary embolism is: A. Chest x-ray B. V/Q lung scan C. 12-lead ECG D. ABG V/Q lung scan A ventilation/perfusion lung scan, also known as a V/Q lung scan, is a type of medical imaging that is used to evaluate the circulation of air and blood within the lungs. The ventilation portion of the exam assesses the ability of air to reach all sections of the lungs, and the perfusion portion evaluates how well blood circulates within the lungs. The test is commonly done to evaluate for the presence of blood clots or abnormal blood flow inside the lungs, such as a pulmonary embolism (PE). Acute respiratory failure is defined as: A. pO2 60 mmHg and pCO2 50 B. pO2 80 mmHg and pCO2 60 C. pO2 60 mmHg and pCO2 30 D. pO2 90 mmHg and pCO2 50 pO2 60 mmHg and pCO2 50 Acute respiratory failure (ARF) exists when breathing fails in its ability to maintain arterial blood gases within a normal range. By definition, ARF is present when the blood gases demonstrate a pO2 60 mmHg (hypoxic respiratory failure) and a pCO2 50 mmHg (ventilatory respiratory failure), which is usually accompanied by fall in the pH 7.3. What personal protective equipment (PPE) should be worn when transporting a patient with bacterial meningitis? A. Mask, gloves, gown, and eye protection B. Gloves only C. Mask and gloves D. Gloves and eye protection Mask, gloves, gown, and eye protection The most common type of decompression sickness typically seen diving emergencies is: A. Musculoskeletal B. Pulmonary C. Arterial gas embolism D. Cutaneous Pulmonary Decompression Sickness (DCS) Musculoskeletal decompression illness (Type I DCS), better known as the "bends," is the most common type of DCS, which may comprise limb or joint pain (shoulder and elbow pain most common), skin rash, pruritus, and joint swelling ("skin bends"). Type II DCS comprises more serious manifestations such as headache, fatigue, visual disturbances, motor/sensory neurologic impairment/deficits, confusion, seizures, coma, and death Situations that involve a LEFT shift in the oxygen-hemoglobin dissociation curve are all of the following, EXCEPT: A. Alkalosis B. Hypocapnia C. Hypothermia D. Increased levels of 2,3-DPG Increased levels of 2,3-DPG The oxyhemoglobin dissociation curve describes the relation between the partial pressure of oxygen and the oxygen saturation. The effectiveness of hemoglobin-oxygen binding can be affected by several factors. Situations that involve a RIGHT shift in the oxygen-hemoglobin dissociation curve are all of the following, EXCEPT: A. Alkalosis B. Hypercapnia C. Hyperthermia D. Increased level of 2,3-DPG Alkalosis Alkalosis causes a left shift. A scaphoid abdomen, unequal breath sounds, dyspnea, and a shift in the PMI are a classic presentation of which of the following in the neonate patient? A. Tension pneumothorax B. Diaphragmatic hernia C. Aspiration pneumonia D. RDS, formerly known as hyaline membrane disease Diaphragmatic hernia Diaphragmatic hernia is caused early in gestation when the pleuroperitoneal cavity fails to close. Abdominal contents migrate into the thoracic cavity, compressing developing lungs and causing pulmonary hyoplasia. Because any distention of the bowel further compromises respiratory function, the transport team should insert a large-bore (10 Fr) orogastric tube and initiate suction. Positive-pressure ventilation with a face mask should be avoided. Hypoglycemia in the neonate can be treated with: A. D 25% 2-4 mL/kg B. D 10% 2-4 mL/kg C. D 10% 5-10 mL/kg D. D 5% 2-4 mg/kg D-10% (2-4 mL/kg) A serum glucose of 40 mg/dL represents hypoglycemia in the newborn. The newborn weighing less than 1,000 g should receive 5% dextrose in water because of their intolerance of the higher glucose loads resulting in hyperglycemia. Hypoglycemia should be treated in the neonate presenting with readings of: A. 70 mg/dl B. 60 mg/dl C. 50 mg/dl D. 40 mg/dl 40 mg/dl A serum glucose of 40 mg/dL represents hypoglycemia in the newborn. Common cause of seizures = hypoglycemia 40 mg/dL and hypoxia Repeated doses of etomidate can cause: A. Increased ICP B. Acute adrenal insufficiency C. AMI D. Pulmonary edema Acute adrenal insufficiency Etomidate (Amidate), which is classified as a sedative-hypnotic can block the adrenal gland's production of cortisol and other steroid hormones, possibly resulting in temporary adrenal gland failure. This may cause abnormal salt and water balance, lowered blood pressure, and, ultimately, shock. Patients with known Addison's disease (acute renal insufficiency) should not be given etomidate. Coronary Perfusion Pressure (CPP) is calculated how? PCWP (pulmonary capillary wedge pressure) A. DBP - PCWP B. DBP + PCWP C. SBP - DBP D. SBP - PCWP CPP = DBP-PCWP (normal 50-60 mmHg) "Cerebral" perfusion pressure which can be calculated by using the following formula: MAP − ICP. Normal range for cerebral perfusion pressure is 70-90 mmHg. Remember that your HEAD is higher than your HEART. Inferior wall MI is caused by an occlusion of which coronary artery? A. LAD B. RCA C. Circumflex D. Inferior vena cava Right coronary artery (RCA) "Lateral Wall" ST elevation in... I, aVL, V5, V6 "Septal Wall" ST elevation in... V1, V2 "Anterior Wall" ST elevation in... V3, V4 "Inferior Wall" ST elevation in... II, III, and aVF Normal CVP/RAP pressures are... A. 15 - 25 mmHg B. 8 - 12 mmHg C. 2 - 6 mmHg D. 8 - 15 mmHg 2 - 6 mmHg Central venous pressure (CVP and Right atrial pressure (RAP) - Reflection of right atrial pressure preload. PCWP (pulmonary capillary wedge pressure) evaluates... A. Right arterial pressures B. Right and left sided heart pressures C. Cardiac output D. Preload to the left side of the heart Preload to the left side of the heart SVR (systemic vascular resistance) measures afterload for the left heart and are Decreased in... A. Hypovolemic shock B. Cardiogenic shock C. Distributive shock D. RVMI Distributive shock If SVR is 800, "think" distributive shock (vasodilatory shock) --- Septic shock, neurogenic shock, or anaphylactic shock If SVR is 1200 "think" hypovolemic shock, cardiogenic shock, or right ventricular myocardial infarction (RVMI) Cardiac output is determined by... A. blood pressure and heart rate B. heart rate and stroke volume C. cardiac index and heart rate D. contractility and preload CO = HR × SV Cardiac output (CO) = 4-8 L/min You are transporting a patient who you note has tea-colored urine in small amount in the foley catheter bag. The nurse reports that his output is only 50 mL in the last twenty-four hours. What treatment would you expect to initiate during the two-hour flight? A. Rapid fluid resuscitation, sodium bicarbonate drip, and consider Lasix and mannitol. B. Rapid fluid resuscitation, potassium replacement therapy, and aggressive pain management. C. Fluid restriction, sodium bicarbonate drip, and consider Lasix and mannitol. D. Fluid restriction, potassium replacement therapy, and aggressive pain management. Rapid fluid resuscitation, sodium bicarbonate drip, and consider Lasix and mannitol. The main goal of treatment is to treat shock and preserve kidney function. After a forced aircraft landing, the pilot is incapacitated; your main priority is to? A. Assume crash position B. Turn off oxygen C. Turn off throttle, fuel, and then battery D. Turn on the emergency locator transmitter (ELT) Turn off throttle, fuel, and then battery You are doing a night flight when you encounter bad weather. The helicopter suddenly impacts the ground and the cockpit is filled with smoke. The best action of the flight team immediately after experiencing the hard landing should be which of the following? A. Grab the fire extinguisher and portable radio. B. Make a call for help on the emergency frequency. C. Exit the helicopter after the aircraft has come to a complete stop and meet at a predesignated position a safe distance from the aircraft. D. Stay in the helicopter as it offers the only available shelter in the area. Exit the helicopter after the aircraft has come to a complete stop and meet at a predesignated position a safe distance from the aircraft. What medications would you expect to administer to a patient presenting with severe chest/abdominal pain, diaphoresis, and is restless? SBP is 170/palp and heart rate in 116. You note a difference in blood pressures when taken on each arm. A. Nitroglycerin and atenolol B. Nipride and b-blockers C. Lasix and nitroglycerin D. Bumex and Dobutrex Nipride and Beta-blockers. Aortic dissection Management: ~ Lower SBP to 100-110 mmHg. ~Beta-blockers blockers to slow the heart rate and decrease ejection fraction (metoprolol, esmolol), pain analgesics. ~ Fluids only if hypotensive. ~ HTN crisis: Nipride, Hyperstat to patient's normal within 30-60 min. ~Surgery On 12-lead ECG, "posterior" wall MIs manifest as... A. ST elevation in II, III, AVF B. ST depression in II, III, AVF C. ST depression in V1-V4 with abnormally tall R waves D. ST elevation in V1-V4 with abnormally tall R waves ST depression in V1-V4 with abnormally tall R waves Acute respiratory failure is defined as: A. pO2 60 mmHg and pCO2 50 B. pO2 80 mmHg and pCO2 60 C. pO2 60 mmHg and pCO2 30 D. pO2 90 mmHg and pCO2 50 pO2 60 mmHg and pCO2 50 Acute respiratory failure (ARF) exists when breathing fails in its ability to maintain arterial blood gases within a normal range. ARF is present when the blood gases demonstrate a pO2 60 mmHg (hypoxic respiratory failure) and a pCO2 50 mmHg (ventilatory respiratory failure), which is usually accompanied by fall in the pH 7.3. A sign of hyperventilation and hypocalcemia is: A. Kehr's B. Grey Turner's C. Trousseau's D. Brudzinski's Trousseau's To elicit Trousseau's sign, a blood pressure cuff is placed around the patient's arm and inflated to a pressure greater than the systolic blood pressure and held in place for three minutes. This will occlude the brachial artery. In the absence of blood flow, the patient's hypocalcemia and subsequent neuromuscular irritability will induce spasm of the muscles of the hand and forearm. The wrist and metacarpophalangeal joints flex, the DIP and PIP joints extend, and the fingers adduct. You are transporting a forty-year-old man from a rural ICU. The CXR reveals a ground glass appearance. The patient is on a ventilator with settings at: Vt 900 mL, rate of 16, FIO2 0.8 with a PEEP of 5. ABG's reveal: pH 7.34, pO2 76, pCO2 38 and HCO3 of 24. What pulmonary condition do you suspect? A. Pneumothorax B. Pulmonary edema C. ARDS D. Cor pulmonale ARDS ARDS, also known as respiratory distress syndrome (RDS); lungs are typically irregularly inflamed and highly vulnerable to atelectasis as well as barotrauma and volutrauma, which leads to impaired gas change, resulting in a severe oxygenation defect (hypoxemia). ARDS was defined as the ratio of arterial partial oxygen tension (PaO2) as fraction of inspired oxygen (FIO2) below 200 mmHg in the presence of bilateral alveolar infiltrates on the chest x-ray. Also, the pulmonary capillary wedge pressure is normal (less than 18 mmHg) in ARDS but raised in left ventricular failure. You would manage a Pt with ARDS by... A. Increasing the rate B. Increasing PEEP C. Performing a rapid needle decompression D. Administering Lasix Increasing PEEP Positive end-expiratory pressure (PEEP) is used in mechanically ventilated patients with ARDS to improve oxygenation. Hypothermia, low levels of 2,3-DPG, and hypocarbia can cause the oxyhemoglobin dissociation curve shift to go... A. Up B. Down C. Right D. Left Left A left shift causes an increase in the affinity, making the oxygen easier for the hemoglobin to pick up but harder to release. * L stands for low/holds onto oxygen. * Low temperature (hypothermia) * Low 2,3-DPG levels, Production decreases with septic shock and hypophosphatemia. * Low pCO2 * There is an "L" in ALKALOSIS In addition to glucose, which electrolyte must be maintained within normal limits when managing a head-injured patient? A. Calcium B. Magnesium C. Potassium D. Sodium Sodium Maintaining serum sodium levels of 145-155 mmol/L is likely to achieve this goal. Low serum sodium levels following traumatic brain injury (TBI) can lead to extracellular volume depletion and cerebral edema. These can all result in dangerous increases in ICP. Hypertonic saline can help avoid the negative effects of hyponatremia by increasing serum sodium levels in the acute phase of head trauma care You are transporting a twenty-year-old male, with penetrating head and facial trauma. During transport, the patient complains of a severe headache, nausea, and vertigo. Your assessment reveals nuchal rigidity, aphasia, dysphasia, along with the patient having episodes of vomiting. What is your diagnosis? A. Pneumothorax B. Pneumocephalus C. Neurogenic shock D. Hypercapnia Pneumocephalus Pneumocephalus is the presence of air or gas within the cranial cavity. It is usually associated with disruption of the skull: after head and facial trauma, tumors of the skull base, after neurosurgery, or with scuba diving (rare). The CT scan of patients with a tension pneumocephalus typically show air that compresses the frontal lobes of the brain, which results in a tented appearance of the brain in the skull known as the Mount Fuji sign. The name is derived from the resemblance of the brain to Mount Fuji in Japan, a volcano known for its symmetrical cone. Calculate the following patient's cerebral perfusion pressure (CPP): BP 180/90, HR 120, RR 24, SpO2 98%, CVP 2, ICP 25. A. 80 B. 120 C. 65 D. 95 95 90 × 2 = 180; 180 × 2 = 360 360 divided by 3 = 120 120-25 = 95 Calculate the following patient's cerebral perfusion pressure (CPP): BP 150/75, HR 140, RR 28, SpO2 100%, CVP 2, ICP 25. A. 98 B. 125 C. 65 D. 75 75 MAP = [(75 × 2) + 150] divided by 3 = 100. CPP = 100-25 = 75 mmHg MAP = [(DBP × 2) + SBP] divided by 3 CPP = MAP − ICP Henry's law best describes which of the following patient conditions? A. Bends B. Barotrauma C. Shallow water blackout D. Arterial gas embolism (AGE) Bends Henry's law states that at a constant temperature, the amount of a given gas dissolved in a given type and volume of liquid is directly proportional to the partial pressure of that gas in equilibrium with that liquid. An everyday example of Henry's law is given by carbonated soft drinks. Poisoning of the cytochrome oxidase enzyme system may cause... A. Histotoxic hypoxia B. Hypemic hypoxia C. Hypoxic hypoxia D. Stagnant hypoxia Histotoxic hypoxia Histotoxic hypoxia interferes with the utilization phase of respiration because of metabolic poisoning or dysfunction. Cyanide, sulfide, azide, and carbon monoxide all bind to cytochrome oxidase, thus competitively inhibiting the protein from functioning, which results in chemical asphyxiation of cells. Methanol [methylated spirits] is converted into formic acid, which also inhibits the same oxidase system. On a long fixed wing flight, an option may be to place water on the ET tube cuff to counteract. Which gas law is it? A. Henry's law B. Graham's law C. Dalton's law D. Boyle's law Boyle's law Boyle's law (expansion or contraction of a gas) describes the inversely proportional relationship between the absolute pressure and volume of a gas, if the temperature is kept constant within a closed system. The air in the ETT cuff, for example, expands with altitude (ascent) and contracts during descent. All of the following are signs of cardiac tamponade, EXCEPT: A. Pulsus paradoxus B. Pulsus alternans C. Kussmual's sign D. Pulseless electrical activity (PEA) Pulsus alternans The patient suspected of having a cardiac tamponade will exhibit signs and symptoms of decreased cardiac output such as, cool, clammy skin, altered mental sratus, tachycardia, pulsus paradoxus (a drop in systolic blood pressure 15 mmHg during normal inspiration), distant muffled heart tones, jugular venous distention, unless the patient is hypovolemic, hypotension, and electrical alternans. What finding would you expect to see on the lateral neck x-ray to confirm suspicion of epiglottitis? A. McDonald's sign B. Steeple sign C. Angel wing sign D. Thumb print sign Thumb print sign The thumbprint sign is a finding on a lateral C-spine radiograph that suggests the diagnosis of epiglottitis. The sign is caused by a thickened free edge of the epiglottis, which causes it to appear more radiopaque than normal, resembling the distal thumb. You are transporting a normotensive patient, who is presenting with a history of head injury and complaining of extreme thirst. Your assessment reveals he is excreting large amounts of diluted urine, sunken appearance to the eyes, dry mouth, and tachycardia is noted. The initial treatment of the patient would be? A. Restrict fluids B. Administer Sandostatin C. Aggressive fluid replacement and vasopressin D. Administer anti-thyroid medication Aggressive fluid replacement and vasopressin The most common type in humans is central DI, caused by a deficiency of arginine vasopressin (AVP), also known as antidiuretic hormone (ADH). The regulation of urine production occurs in the hypothalamus, which produces ADH. The hormone is stored for later release in the posterior lobe of the pituitary gland. The cause of central diabetes insipidus is usually damage to the pituitary gland or hypothalamus, most commonly due to surgery, a tumor, illness (such as meningitis), inflammation or a head injury. Your patient presents upper body obesity with thin arms and legs. He has a rounded face "buffalo hump" and is complaining fatigue. He is hypertensive and hyperglycemic. What condition is he most likely presenting? A. Myxedema coma B. Thyroid storm C. Addison's disease D. Cushing's syndrome Cushing's syndrome * Hyperaldosteronism * Hypertension * Women have facial hair, moon-face, buffalo hump * Fatigue * Upper body obesity, thin arms and legs * Treatment: decrease or initiate steroids You are transporting a sixty-year-old man complaining of severe chest pain and midscapular pain. He is short of breath and is hypertensive in the upper extremities. You auscultate a harsh systolic murmur. Your diagnosis of this patient is... A. Cardiac tamponade B. Aortic rupture C. Myocardial rupture D. Tension pneumothorax Aortic rupture Aortic rupture with 90% of patients who die at the scene. Chest x-ray findings: widening mediastinum and loss of aortic knob shadow. After administering fluid resuscitation, performing vigorous fundal massage and giving oxytocin, your patient continues with postpartum hemorrhage. Which drug would be indicated to decrease blood loss? A. Apresoline B. Methergine C. Terbutaline D. Magnesium sulfate Methylergonovine (Methergine) 0.2 mg administered intramuscularly or intravenously, is recommended. Methylergonovine should be used cautiously in patients with PIH because of the pressor effects that may result in further elevated blood pressure. Methylergonovine is a blood vessel constrictor and smooth muscle agonist most commonly used to prevent or control excessive bleeding following childbirth and spontaneous or elective abortion. It also causes uterine contractions to aid in expulsion of retained products of conception after a missed abortion and to help deliver the placenta after childbirth. Side effects can include nausea, vomiting, diarrhea, cramping, dizziness, pulmonary hypertension, coronary artery vasoconstriction, and severe systemic hypertension (especially in patients with preeclampsia). Overdue aircraft procedures during flight start after: A. 15 minutes without contact B. 30 minutes without contact C. 45 minutes without contact D. 60 minutes without contact 45 minutes without contact Time between each communication should not exceed 15 minutes while in flight unless a system of continuous automatic position tracking is utilized or 30 minutes on ground transport. Time between communications should not exceed 45 minutes while on the ground. Who has the ultimate authority to initiate or complete a mission? A. The flight paramedic B. The flight nurse C. The PIC D. The communication specialist The PIC (Pilot) Platelets are considered low at: A. 600 B. 450 C. 240 D. 150 150 In an adult, a normal count is about 150,000-400,000 (150-450) platelets per microliter of blood. If platelet levels fall below 20,000 per microliter, massive bleeding may occur and is considered a lifethreatening risk. How should your flight suit fit to provide space of insulation per CAMTS recommendations? A. ½ in. B. 1 in. C. Skin tight so I look really hot for the firefighters on scene D. ¼ in. 0.25 in. (1/4 in.) The absolute minimum hours required by the Federal Aviation Regulation (FAR) Part 135 with regard to a pilot's "bottle to throttle" rule is... A. 8 B. 12 C. 24 D. 48 8 Pilots need to be mindful that the "eight-hour bottle-to-throttle" rule is the absolute minimum. Some individuals may require a longer period between drinking and flying depending on the amount of alcohol consumed and their personal metabolism. You are doing a night flight when you encounter bad weather. The helicopter suddenly impacts the ground and the cockpit is filled with smoke. The best action of the flight team immediately after experiencing the hard landing should be which of the following? A. Grab the fire extinguisher and portable radio. B. Make a call for help on the emergency frequency. C. Exit the helicopter after the aircraft has come to a complete stop and meet at a predesignated position a safe distance from the aircraft. D. Stay in the helicopter as it offers the only available shelter in the area. Exit the helicopter after the aircraft has come to a complete stop and meet at a predesignated position a safe distance from the aircraft. Usually meeting at the nose of the aircraft, which is twelve o'clock position. The MD has ordered a brain natriuretic peptide (BNP), which would evaluate the patient for... A. Sepsis B. Hypovolemia C. Right ventricular MI D. CHF CHF BNP is a blood test used to measure the amount of BNP hormone in the blood. BNP is produced by the heart and shows how well the heart is functioning. Normally, only a low amount of BNP is found in the heart. But if the heart has to work harder for a longer period of time, such as in heart failure, the heart releases more BNP, increasing the blood level of BNP. In some cases, this test can diagnose heart failure in a patient who does not have obvious heart failure symptoms. BNP values tend to increase with age and are higher in women than men. Lab findings — Normal BNP level: 0-99 picograms per milliliter (pg/mL). Abnormal BNP level: 100 pg/mL or greater is indicative that heart failure may be present. The ELT takes a minimum of ____________ g's to activate. A. 2 B. 4 C. 6 D. 8 4 The ELT is activated by an impace exceeding 4g's and broadcasts on the universal distress channel 121.5. Preeclampsia is characterized by of the following, EXCEPT: A. Hypertension B. Edema C. Proteinuria D. Seizures Seizures or Low Platelet Count Preeclampsia is characterized by hypertension, proteinuria, and edema. Hemolytic disease of the newborn can be prevented by the administration of which of the following to a Rhesus negative mother who had a pregnancy with a Rhesus positive infant? A. Albumin B. Rho(D) immune globulin C. Steroids D. Indomethacin Rho(D) immune globulin The commonly used terms Rh factor, Rh positive, and Rh negative refer to the D antigen only. Rho(D) immune globulin is a medicine solution of IgG anti-D (anti-RhD) antibodies used to prevent the immunological condition known as Rhesus disease (or hemolytic disease of newborn). When the disease is mild, the fetus may have mild anemia with reticulocytosis. When the disease is moderate or severe, the fetus can have a more marked anemia and erythroblastosis (erythroblastosis fetalis). When the disease is very severe, it can cause morbus hemolyticus neonatorum, hydrops fetalis, or stillbirth. Stagnant hypoxia Occurs when conditions exist that result in Reduced total Cardiac Output, "pooling of the blood" within certain regions of the body, a decreased blood flow to the tissues, or restriction of blood flow. Which of the following paralytics stimulates motor end plate acetylcholine receptors causing persistent depolarization? A. Succinylcholine B. Rocuronium C. Vecuronium D. Pancuronium Succinylcholine Neuromuscular blocking agents (NMBA) binds with cholinergic receptor sites of motor neurons preventing the neurotransmitter from relaying the signal. The interruption in this signal pathway is what causes paralysis. Succinylcholine (anectine) is classified as a noncompetitive depolarizing agent because it binds with the motor end-plate receptor site, causing a continuous depolarization to take place. It is this depolarization that causes the initial fasciculations (irregular muscle contractions produced by depolarization of the muscle membrane before complete cessation of muscle activity). As the acetycholinesterase enzyme breaks down the NMBA, there is a return of fasciculations. When administering a defasciculating neuromuscular blockade, the dose recommended is? A. 5% normal RSI dosage of NMBA B. 10% normal RSI dosage of NMBA C. 15% normal RSI dosage of NMBA D. 20% normal RSI dosage of NMBA 10% normal RSI dosage of NMBA The administration of a defasiculation dose of a competitivenon depolarizing NMBA, such as vecuronium (Norcuron), can prevent fasciculations that occur when succinylcholine (Anectine) is administered. Administration of 10% of the initial NMBA dose is recommended to prevent this complication, especially in trauma patients who have sustained significant skeletal fractures for the purpose of preventing further injury at the fracture site/s. In aviation, "You may fly instrument flight rules (IFR) in visual meteorological conditions (VMC), you cannot fly VFR in _________." A. VMC B. IFR C. Instrument meteorological conditions (IMC) D. DMC Instrument meteorological conditions (IMC) In aviation, VMC is an aviation flight category in which VFR flight is permitted—that is, conditions in which pilots have sufficient visibility to fly the aircraft maintaining visual separation from terrain and other aircraft. They are the opposite of IMC. IMC, sometimes referred to as blind flying, is an aviation flight category that describes weather conditions that normally require pilots to fly primarily by reference to instruments, and therefore under IFR, rather than by outside visual references under VFR. Typically, this means flying in cloud, bad weather or at night. So the rule is, you may fly IFR in VMC, but you cannot fly VFR in IMC. It is important not to confuse IMC with IFR —"IMC" describes the actual weather conditions, while "IFR" describes the rules under which the aircraft is flying. Aircraft can (and often do) fly IFR in clear weather, for operational reasons, or when flying in airspace where flight under VFR is not permitted; indeed by far the majority of commercial flights are operated solely under IFR. The number one cause of aero-medical crashes is: A. Pushing the weather (weather-related) B. Pilot fatigue C. Night missions D. Flying IFR in VMC Pushing the weather (weather-related) You are managing a 100-kg burned patient with 70% BSA. How much fluid will the patient receive in the first eight hours using the Consensus formula? A. 14,000-28,000 mL B. 7,000-14,000 mL C. 3,500-7,000 mL D. 28,000 mL 7,000-14,000 mL 2 × 100 = 200; 200 × 70 = 14,000; half is administered in the first eight hours = 7,000 mL (is the lower end of the Consensus formula). Consensus formula (Parkland and modified Brook formulas combined) [(2-4 mL × weight in kg) × % TBSA] = Total fluids in twenty-four hours with half of the total fluids calculated administered in the first eight hours and the rest in the subsequent sixteen hours. Management of cyanide toxicity includes all of the following, EXCEPT: A. Amyl nitrate B. Sodium nitrate C. Protopam chloride D. Sodium thiosulfate Protopam chloride (2-PAM) Pralidoxime chloride (2-PAM, protopam) is a nucleophilic agent that reactivates the phosphorylated AChE by binding to the OP molecule. Used as an antidote to reverse muscle paralysis, resulting from OP AChE pesticide poisoning but is not effective once the OP compound has bound AChE irreversibly (aged). ARDS and DIC are a result of what in the hyperthermic patient? A. Temperature increase B. Lysosomal enzymes C. Release of sodium D. Retention of potassium Lysosomal enzymes Muscle damage is evidenced by rhabdomyolysis. Elevated creatine phophokinase (CPK) values are a diagnostic hallmark of heatstroke because of the rhabdomyolytic process. The release of destructive lysosomal enzymes occurs as a result of extensive muscle damage, which can lead to ARDS, DIC, and ATN. Levine's sign relates to... A. Meningitis; neck pain B. Pancreatitis; periumbilical bruising C. Cardiac; clenched fist over chest D. Splenic injury; left shoulder Cardiac; clenched fist over chest Pt clutching their chest, which may indicate that pain may be cardiac in origin. The circulating blood volume in a child is? A. 10-20 mL/kg B. 20-40 mL/kg C. 50-60 mL/kg D. 70-80 mL/kg 70-80 mL/kg Small amounts of fluid or blood loss can cause serious physiologic effects. The goal in supporting cardiac output in shock is the replacement of lost circulating volume. Circulating blood volume in Newborns? 80 mL/kg Circulating blood volume in Pediatrics? 70-80 mg/kg Circulating blood volume in Adults? 60 mL/kg Pediatric airway anatomy differs from adult anatomy in the following ways, EXCEPT: A. Airway diameter in children is smaller than adults B. The larynx is located more anterior in infants and children C. The epiglottis is long and narrow and angled away from the trachea. D. In children, younger than six years of age, the narrowest portion of the trachea is at the cricoid process. In children, younger than six years of age, the narrowest portion of the trachea is at the cricoid process. In children younger than "10 years of age", the narrowest portion of the trachea is at the cricoid process. The vocal cords are attached lower anteriorly and the tongue (especially in infants) is proportionately larger. Pediatric - "10, 11, 12" Rules Uncuffed tube under 10 Needle cricothyrotomy only under 11 No nasal intubation under 12 Late decelerations may indicate... A. Cord compression B. Acidosis C. Anemia D. Uterine placental insufficiency Uterine placental insufficiency A late deceleration is one that begins close to the apex of the contraction, gradually decelerates, and gradually returns to the FHR baseline after the contraction is over. Late decelerations always indicate uteroplacental insufficiency; there is inadequate oxygen exchange in the placenta during a contraction. When a contraction is stronger, the insufficiency is greater and the deceleration is proportional. Late decelerations are one of the most ominous fetal heart rate patterns. All of the following are considered stressors of flight, EXCEPT? A. g-forces B. Increased partial pressure of oxygen C. Barometric pressure D. Decreased humidity Increased partial pressure of oxygen You are transporting a twenty-five-year-old woman with a history of suspected overdose. The following ABGs were obtained prior to your arrival at the sending facility: pH 7.52, pCO2 27, HCO3 24, pO2 110. You would most likely suspect: A. Narcotic overdose B. TCA overdose C. Early salicylate poisoning D. Insulin overdose Early salicylate poisoning The ABG interpretation of a pH 7.52, pCO2 27 and HCO3 24 is a noncompensated respiratory alkalosis, which is present is early salicylate poisoning. The metabolic changes eventually lead to renal depletion of fluids and electrolytes, hypoglycemia, hypokalemia, and a mixed presentation of respiratory and metabolic alkalosis coupled with metabolic acidosis, which may provoke cardiac dysrhythmias, acute pulmonary edema, renal failure or neurological injury. The clinical presentation of salicylate poisoning can also include gastrointestinal bleeding and an unexplained elevated anion gap (metabolic acidosis). Salicylate levels are obtained four to six hours after ingestion. Earlier samples may be unreliable because the pharmacokinetics is not stable before that time. The most important information in assessing severity, however is the patient's clinical condition. If the PIP does not change on a ventilator patient with respiratory acidosis, always... A. Increase Vt before rate B. Decrease Vt before rate C. Increase rate before Vt D. Decrease rate before Vt Decrease Vt before rate Elevated peak inspiratory pressures (PIP) can be managed by decreasing the flow rate and tidal volume initially. If necessary, increasing the respiratory rate can be done to correct an underlying respiratory acidosis. Trouble-shooting high-pressure alarms on the ventilator can be caused by all of the following, EXCEPT: A. Secretions B. Obstructions C. ET tube main-stem placement D. Leak in ventilator tubing Leak in ventilator tubing Leaks and/or loose connections are associated with low ventilator alarms. Normal range for right atrial pressure is: A. 2-6 mmHg B. 8-12 mmHg C. 4-8 mmHg D. 0-5 mmHg 2-6 mmHg Systemic vascular resistance (SVR) measures? Afterload for the Left heart The most likely causes of Metabolic Alkalosis can include all of the following, EXCEPT: A. Vomiting B. NG suctioning C. Diarrhea D. Diuretics Diarrhea Diarrheal dehydration can cause metabolic acidosis, especially in the pediatric patient. Metabolic alkalosis can be caused by loss of hydrogen ions through the kidneys or GI tract. Vomiting or nasogastric (NG) suction generates metabolic alkalosis by the loss of gastric secretions, which are rich in hydrochloric acid (HCL). Renal losses (use of diuretics) of hydrogen ions occur when the distal delivery of sodium increases in the presence of excess aldosterone, resulting in reabsorption of sodium, leading to the secretion of hydrogen ions and potassium ions. The administration of sodium bicarbonate in amounts that exceed the capacity of the kidneys to excrete this excess bicarbonate may cause metabolic alkalosis. Shifting of hydrogen ions into the intracellular space can also occur, which is mainly seen with hypokalemia. Digitalis toxicity can easily be exacerbated by... A. Acute MI B. Electrolyte abnormalities C. Undiagnosed diabetes D. Beta-blockers Beta-blockers A group of medicines extracted from foxglove plants are called "digitalin." The use of digitalis purpurea extract containing cardiac glycosides for the treatment of heart conditions is used to increase cardiac contractility (positive inotrope) and as an antiarrhythmic agent to control the heart rate, particularly in atrial fibrillation. Digitalis is often prescribed for patients in atrial fibrillation, especially if they have been diagnosed with CHF. Digitalis works by inhibiting sodium-potassium ATPase. This results in an increased intracellular concentration of sodium, which in turn increases intracellular calcium by passively decreasing the action of the sodium-calcium exchanger in the sarcoplasmic reticulum. The increased intracellular calcium gives a positive inotropic effect. Digitalis poisoning can cause heart block and either bradycardia or tachycardia, depending on the dose and the condition of the patients heart. The classic drug of choice for VF (ventricular fibrillation) in the emergency setting, amiodarone, can worsen the dysrhythmia caused by digitalis; therefore, the second-choice drug lidocaine is more commonly used. Your patient ingested an unknown toxin. The electrocardiogram recorded on ER admission shows a minimally irregular wide-QRS tachycardia with a long QT interval. The most likely cause is? A. TCA overdose B. Early digitalis overdose C. Calcium channel blocker overdose D. Beta-blocker overdose TCA overdose When assessing CVP or PA, pressures on a mechanically ventilated patient, assess pressures at the ______ of exhalation? Assess pressures at the END of exhalation Your patient's PA waveform is in wedge position. You would... A. immediately withdraw the catheter to 20 cm depth. B. have the patient cough forcefully C. verify chest tube drains are vented appropriately D. inflate the PA catheter balloon to 1.5 mL Have the patient cough forcefully. Have the patient cough forcefully in an attempt to dislodge the balloon. Assure that the balloon is completely deflated, and have the patient lie on their side. Cullen's sign may indicate... A. Meningitis B. Pancreatitis C. Gallbladder disease D. Cardiac problem Pancreatitis Cullen's sign (periumbilical bruising) Kussmaul's sign is a... A. Rise in venous pressure with inspiration B. Crunching sound synchronized to heart beat C. Decrease of the SBP of 10 mmHg with inspiration D. Marbled appearance of the abdomen Rise in venous pressure with inspiration Kussmual's sign is a rise in venous pressure with inspiration (JVD), which can be indicative of (RVI) and cardiac tamponade. Murphy's sign Right upper quadrant pain, may indicate gallbladder disease. Grey Turner's sign Retroperitoneal bruising, may indicate pancreatitis or trauma. Cullen's sign Periumbilical bruising, may indicate pancreatitis or intra-abdominal bleeding. Halstead sign Marbled appearance of the abdomen, may indicate necrosis of the pancreas. Kehr's sign Shoulder pain, may indicate spleen injury on the left side or ectopic pregnancy/rupture on either side. Hamman's sign Crunching sound heard with auscultation, may be synchronized with heart rate/pulse, may indicate tracheobronchial injury.